SSA-159 (current)

Social Security Administration

Form Approved
OMB No.0960-0757

GSO Website Registration Form

Complete the following information to obtain access to GSO services. SSA Sponsors should email the completed form to UIT.eData.
Mailbox@ssa.gov. Each new user will receive an email containing the Username, and a phone call to provide the password.
Please tab from field to field.
GSO USER - CONTACT INFORMATION
Name:

SSA SPONSOR VERIFICATION (FOR COMPLETION BY SPONSOR
ONLY):
Phone:

Sponsor Name:

Organization Name:

(Include area code)

Organization ID or RID:

Sponsor Organization (Office/Division/Branch):

Street Address (Line 1):

Sponsor Email address:

Street Address (Line 2):
City:

Zip
Code:

State:

FOR DATA EXCHANGE, SHELTERED WORKSHOP, AND SECURE
MESSAGING ONLY: list all Trading partners with whom the user
will exchange data.

Email Address:
Phone (Include area code):
For SSA internal users only:
Select user type:

Sponsor Comments:

Name

User ID

Organization/State

Select One

SELECT UTILITIES THE NEW USER WILL NEED TO ACCESS:

Select Utilities
Select Utilities

Select Utilities
Select Utilities

Form SSA-159 (07-2010)

For UIT use only.
Paperwork Reduction Act Notice: This information collection meets the requirements
of 44 U.S.C. §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. You may send
comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD
21235-6401. Send only comments relating to our time estimate to this address, not the
completed form.