Information Collection

SSA-120 Internet Version Application for access to SSA Systems

IC 212360 under ICR 202607-0960-003 · OMB 0960-0791.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Electronic SSA-120 (revised).pdf	Other-Screens
Privacy Act Statement (revised).docx	Other-Privacy Act Statement (revised
Electronic SSA-120 (current).pdf Electronic SSA-120 - Current	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 401.45 26 CFR 31.6011(b)2 26 CFR 31.6109-1

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screens					Yes	Yes	Fillable Fileable Signable
Other-Privacy Act Statement (revised)					Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,482

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,482	-685	2,167
Annual IC Time Burden (Hours)	49	-23	72
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Electronic SSA-120 - Current		07/24/2026

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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