SSA-160 (current)

Form Approved
OMB No. 0960-0757

Social Security Administration

GSO Website Account Modification/Deletion Form
Sponsors should complete this form to request modification or deletion of a GSO website user account. SSA sponsors should email thecompletedformtoUIT.eData.Mailbox@ssa.Qov.
Sponsors will receive email notification when the request has been processed.
Please tab from field to field,
USER ACCOUNT INFORMATION

REQUEST INFORMATION
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User Name):

Date of Request:
Type of Request:

Select user type:

Select One

(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 10 to be changed:

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Organization Name:

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Organization 10 or RID:

--------,

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Email Address:

Explanation:

Phone (Include area code):

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Select the utilities to which the user will need access:

Office:

(select all that apply to this user)

Select Utilities

SPONSOR INFORMATION

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hone:

Sponsor Name:

MODIFICATION REQUEST

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Select One

Include area code)

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Email:

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Select Utilities

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Select Utilities

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ACCOUNT STATUS - For Completion By UIT
Status: Request Submitted

1

Select Utilities

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Processed by:

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, I Completion Date: ~~hone:
Include area code)

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Comments:

Comments:
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Paperwork Reduction Act Notice: This information collection meets the requirements
of 44 US.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

Form SSA-160 (07-2010)

See Revised Paperwork
Reduction Act Statement

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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.

SSA will insert the following revised Privacy Act Statement into the form
at its next scheduled reprinting:
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 Security office.

SSA will insert the following revised PRA Statement into the form at its
next scheduled reprinting:
Paperwork Reduction Act Statement - 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. Send only
comments relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore,
MD 21235-6401.