Application for Access to SSA Systems

Forms and Documents

Document Name	Status
Form SSA-120 Application for Access to SSA Form and Instruction	Modified
Justification for Non-substantive change (revised).doc Justification for No Material/Nonsubstantive Change	2012-04-26

IC Document Collections

IC ID	Document Title	Status
198898	Application for Access to SSA Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0791	ICR Reference No: 201204-0960-017
Status: Historical Active	Previous ICR Reference No: 201108-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Access to SSA Systems
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/05/2012
	Date Received in OIRA: 05/01/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	01/31/2015	01/31/2015
Responses	4,313	0	4,313
Time Burden (Hours)	144	0	144
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses the Form SSA-120 to provide a Personal Identification Number for access to SSA's IT resources. SSA only uses the SSA-120 form for obtaining access to SSA systems. The request must adhere to the minimum access necessary to perform the respondents duties. SSA requires supervisor approval, and local or Component Security Officer review are prior to granting the requested access. The respondents are SSA employees and non-Federal Employees (contractors) needing access to SSA systems. This is a request for non-substantive changes to the collection.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 55999	09/09/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 72994	11/28/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Access to SSA	SSA-120	Application For Access to SSA Systems

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	4,313	4,313	0	0	0	0
Annual Time Burden (Hours)	144	144	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This new collection increases the public reporting burden. See question #12 of the Supporting Statement for updated burden figures.

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/01/2012

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