Form SSA-160 Government to Government Services Online Website Account

Form SSA-160 (07-2017)
Discontinue Prior Editions
Social Security Administration

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OMB No: 0960-0757

GSO Website Account Modification/Deletion Form
Sponsors should complete this form to request modification or deletion of a GSO web site user account. SSA sponsors should
email the completed form to [email protected]. Sponsors will receive email notification when the request has
been processed.
Please tab from field to field.

REQUEST INFORMATION
Date of Request:
Type of Request:

Account Modification

Account Deletion

(Note: Deletion requests for organizational shared accounts will delete the entire account where no one on that account will have
access to the website.)
User ID to be changed:
Explanation:

MODIFICATION REQUEST
Select the utilities to which the user will need access:
(Select all that apply to this user)
B - Birth

BL - Black Lung

DE - Data Exchange

D - Death

FF - Fugitive Felon

PR - Prisons

DDE - Totalization Death Data Exchange

OCSE - OCSE Reporting

SM - Secure Messaging

IAR - Interim Assistance Reimbursement

SW - Sheltered Workshop

Other - Specify Utility in Comments
Comments:

USER ACCOUNT INFORMATION
User Name:
Select User Type:
Organization Name:

Individual User

Organizational Shared Account
Organization ID or RID:

Email Address:

SPONSOR INFORMATION
Sponsor Name:
Office:
Email:

Phone (Include area code):

Form SSA-160 (07-2017)

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ACCOUNT STATUS - For completion by UIT
Request Submitted

Status:
Processed by:

Request Processed

Completion Date:
Phone (include area code):

Comments:

Privacy Act Statement
Collection and Use of Personal Information
Section 205(a), of the Social Security Act, as amended, 5 U.S.C. 552a(e)(10), and the Government
Paperwork Elimination Act, authorize us to collect this information. We will use the information you provide
to determine eligibility to access Government Services Online (GSO).
The information you furnish on this form is voluntary. However, failure to provide the requested information
may prevent us from granting access to GSO.
We rarely use the information you supply for any purpose other than for determining eligibility for access.
However, we may use it for the administration and integrity of Social Security programs. We may also
disclose information to another person or to another agency in accordance with approved routine uses,
which include but are not limited to the following:
1. To comply with Federal laws requiring the release of information from Social Security records
(e.g., to the Government Accountability Office and Department of Veterans Affairs);
2. To facilitate investigative and audit activities necessary to assure the integrity of Social Security
programs.
We may also use the information you provide in computer matching programs. Matching programs compare
our records with records kept by other Federal, State, or local government agencies. Information from these
matching programs can be used to establish or verify a person's eligibility for Federally-funded or
administered benefit programs and for repayment of payments or delinquent debts under these programs.
Additional information regarding this form, routine uses of information, and our programs and systems, is
available on-line at www.socialsecurity.gov or at your local Social
SeeSecurity
Revisedoffice.
Privacy Act
meets the requirements of 44 U.S.C. §
Paperwork Reduction Act Statement - This information collection
Statement
3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these
questions unless we display a valid Office of Management and Budget control number. We estimate that it
will take about 15 minutes to read the instructions, gather the facts, and answer the questions. Send only
comments relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.