Addendum to the Supporting Statement - 0791

Addendum to Supporting Statement for Form SSA-120

Application for Access to SSA Systems

20 CFR 401.45

OMB No. 0960-0791

Revisions to the Collection Instrument

SSA is making the following revisions to the SSA-120 pdf version:

• Change #1: SSA intends to provide Form SSA-120 in a fillable PDF file on our website, in place of the non-fillable PDF version we currently provide. We propose to make all form entries fillable.

• Justification #1: This change will allow the respondents to continue to print and complete the form by hand, or, alternatively, complete the form using a computing device, such as a personal computer or handheld (mobile) device, print, and submit the form to SSA for processing

• Change #2: We are revising the language in field #7 in the Application section.

Old Language: SSA COMPONENT NAME OR EXTERNAL ORGANIZATION NAME –

New Language: SSA Component and Security Department or External Organization

Justification #2: We revised language to include SSA Security Department.

• Change #3: We revised the language in section to Instructions for Completing the Application for Access to SSA-Systems. Field #7:

Old Language: SSA field employees should enter the name of their field office. SSA non-field office employees should enter their component name. All others enter the name of your employing company or agency,

New Language: SSA field employees should enter the name of their field office and Security Department. All others enter the name of your employing company or agency. Security Department Example: Dept.: DOISDSE.

Justification #3: Changed content in field 7 to reflect the SSA field employees should also enter the name of their Security department. The new content further gives an example of what the Security Department field should include.

• Change #4: We are revising the langue in section: Disposition of the Completed Form, the content in #2:

Old Language: Office of Disability Adjudication and Review Regional and Field personnel – Send the form through the Security Officer in the ODAR Regional Office to the Component Security Officer, 5107 Leesburg Pike, Falls Church, VA 22041-3255

New Language: Office of Hearing Operations Regional and Field Personnel – Send the form through the Security Officer in the OHO Regional Office to the Component Security Officer, 5107 Leesburg Pike, Falls Church, VA 22041-3255

Justification #4: We made revisions to update the agency and component to whom the form should be sent.

• Change #5: We are revising the language in the section: Disposition of the Completed Form, the content in # 3 changed from:

Old Language: For access to the ESEF- Component Security Officer (CSO) should send the signed/complete form to: OESAE Component Security Officer, 4-N-28 Operations Building.

New Language: For access to the ESEF- Component Security Officer (CSO) should send the signed/complete form to: OSA Component Security Officer, 3G6D Perimeter East Building.

Justification #6: We are revising to show the accurate component and building.

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• Change #7: Revised Privacy Act Statement for Collection and Use of Personal Information. Consolidated this section to one area within the document.

Justification #7: The privacy statement needed revision per policy, and was redundant in two places within the document.

SSA is making the following revisions to the SSA-120 Webpage:

• Change #8: We are adding the SAM homepage screen prior to application to identify the purpose of the request. Is the requestor requesting SAM access for himself/herself, somebody else or are they requesting to view their access list? These options should be identified by the requestor prior to initiating the request.

Justification #8: We are adding the SAM homepage to guide users to the options and appropriate requests.

• Change #9: We are changing the order of pages to: SAM home page; SSA-120 information page; Application; Privacy Act Statement; Pending Request; and Completed Requests,

Justification #9: We are changing the order of pages to give the user pertinent information in regards to the electronic form.

• Change #10. We are adding an addition to the Privacy Act Statement.

Justification #10: The addition to the privacy statement was relevant as it pertains to policy, rights, procedures and privileges. Users should understand the policies, rights, procedures and privileges as it pertains to privacy.