OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

SSA-120 Internet Version Application for access to SSA Systems

IC 212360 under ICR 202103-0960-004 · OMB 0960-0791.

Documents and Forms
Document Name
Document Type
Other-Screens
Other-Screens
Other-Privacy Act Statement (revised
Other-Privacy Act Statement (revised
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

SSA-120 Internet Version Application for access to SSA Systems
 
No Modified
 
Voluntary
 
26 CFR 31.6109-1 26 CFR 401.45 26 CFR 31.6011(b)2

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screens Electronic SSA-120 - Revised.pdf Yes Yes Fillable Fileable Signable
Other-Privacy Act Statement (revised) Privacy Act Statement 0791.docx Yes No Printable Only

Income Security General Retirement and Disability

 

2,167 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,167 0 685 0 0 1,482
Annual IC Time Burden (Hours) 72 0 23 12 0 37
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Electronic SSA-120 - Current Electronic SSA-120 (current).pdf 04/28/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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