View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	SSA-120 Internet Version Application for access to SSA Systems	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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

Information Collection Instruments:

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

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,167	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 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

Documents for IC

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.