Request for Internet Services - Password Authentication (Internet)

Request for Internet Services - Password (RISPA)

RISPA Internet Screens

Request for Internet Services - Password Authentication (Internet)

OMB: 0960-0632

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0632 can be found here:

Document [pdf]

Download: pdf | pdf

09/16/2009

Get PRe

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SUt'ia I Sl't'urity ( )n line SClyiel'S

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~ About Password Services

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Social Security provides this website for your convenience.

Llmltatlont:

• This website can be used to get a password for .onUne and automated
telephone S8Mce access to your personal account If you ...e I
repre.entall'lle payee for another person you cannot get a password to
access their information .
• For securi~ reasons, there are time limits foryourwor!<. on each page You
Will receive a wamlng after 25 minutes, and you Will be able to emnd your
~me on the page After the third waming on a page, you must move to
another page or your time Will run out and your work on that page Will be
lost If you have tumed JavaScript off in your browser, you Will not receive
these warnings. After spending 30 minutes on a page. you must move to
another page or you Will be togged out.

Do not u.e the SIck button on your bro_er to move blckwII'd. Ute the
Prior Plge button Inltaad.
Do not ute the EntII' key to move around In the form. Use the Continue
button Inltaad.
Special Instructions!gr People Who Are Blind

l'ht PrI'IIacy Act

stlltem~:

See Revised Privacy Act Statement Attached

Paperwork Reduction Act:

Social Security is allowed to colleetthe facts on this form under Section 205 of
the Social Securl~ Act We need these facts t.o QUickl'{ identity V'ItIo you are and
provide the information you requested. Giving us these facts is voluntary
However, Without them we may not be able to give you the information that you
want. The Social Security Administration Will nol usa the jnforma~on for any
other purpose.
ThIS information collection meets the clearance reqUirements of 44 USC §
3507, as amended by section 2 01 the PapelWo", Reduction Act of 1996.
You do not need to answer these questlOns unless we display a valid OffIce of
Management and Budget (OMB) control number The OMB control number for
this form is 0960-0632; e)(piration date 10131/2009. We estimate that it Will take
about 2 Y. minutes to read the instruc~ons. gather the necessary feets. and
answer the questions You may send comments on our time estimate to SSA,
6401 Securl~ Blvd. Balbmore, MD 21235-6401. Send only comments on our

time estimate to this Iddrell, not the completed form.

Get PRe

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09/16/2009

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St It'lai Sl't'urit~ ( )nJine St'ni'cs

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Password Services
The Soci al Security Admmistration can issue you a permaneotpassword to
access, fErt1liiW or 'change your personal information eitlier online or bY using our
automated telephone seMce.

RequntJng and crelltlng • permenent password Involve, .3 step
proe....
1f~"'t;lntly fliid for
b.~d':

And said "Yes" When asked about gelling a password. SkIp sttp 1. We wm
automatically mall you a temporary Password Requsst Code (PRe) letter

For 1II'l#llIrp••aword
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You need to get • temporary Pauword Request Code
(pRe) Which wiD be mailed to the address we have on record for
you. Your PRe will be used to create your permanent password.

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Wait to receive your PRe letter In the mail. It could tlke I. long
u 16 days to rectlve your PRe, after you reQU$! it, or alter
you receive your benefits award notice (If you recenlly filed for
benefits).

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Create your permanent pasaword bY providing additional
information and using your PRC. Which you received in the mail.

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You are Hmlttd to three PRe requnta per year,

r you know your current permanent password, you can change it here

If you

have forgotten it, you must get a new PRe.
O1",ngeYQIJl'Pe.~'!l'Io";L

If yoU·ionqt.....lIOt';OI'l~\

R,.... tQY9Uf P''''oftll
Infonriet~!..·..

&llecting "Slock Electronic Access" will block all online and automated
telephone semte access to your personal information.

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GetPRC

09/16/2009

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. j Q Get A Temporary Password Request Code
If you said ''Yes'' v.nen asked about geIIlng a password, we will automallcally
mail you a temporary Password Request Code (PRe) Ietler.1t could tlke_
Iong_16 daytl to recelYt your PRC In the mall atter you receive your
~nefit award notice. Select "EJdr' and weit to receive your letter

You need to get. temporary P_lIWOrd Rtqu..t Code (PRe) which WID
be mailed to the address we helle on record for you if:
• You have never requtlsted a PRe
• You lost your permanent password or PRe.
• The eJtpiration date on your PRe leiter has passed.
. Your PRe will be used to create your permanent password To request •
PRe, Hied "Continue",
If you r$!,

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SOl'ial SCl'urit) ( )IlIiIW Sl'lyil't's

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,AlI:kr1IOW1edIa,ement For OnfU18 Services
UMPORTANT: You can'usethfsW9bsita-iQgain-eicass toyoutpersoo"af' . : ,,-' i
.

U sre sdiog 00 behalf ofanottler person, or If you are II
Payee. you cannot use this online seMce and should contact iii
~.._"__.!epTesentative.

Arty person who kno"';ngiy and wll!ngiy makes arty representation
1. that is false to obtalninfoTlM!lon from SOCial SeCulilyre.cords. and/or
:2 thai: is Intended to deceivelhe Social Seculily Administration as to the true
id$l1ti1y Of the indl't'idulill,
(ould be punl!;had by a fine or iff4')rtsonment. or both. The OMS control number
for this form is 096()'0632; expiration date 101311200Q.

Iha.,. read end agr..d to the libov, atatement.llIm ttt,lndlYlduIJ Whoa.
personlllnformltlon I lim requHtlng.

You may call us Mondaythrough Friday: 7:00 AM· 7;00 PM at

NIOO·772.t213
If you are daaf or hard-of·hearing, call our toli-free iTY number.

1-800..32,1.0718

09/16/2009

GetPRC

First name; middle lnitial,lt any; last
name; Suffix, it art;

other hilt name:
For example, your name as shown
on a recent letter from Sodal
Security or your maiden name

Enter Your Social Security
number:
Enter numbers lllilhout dashes, tor
example. 123456789

select vour dlle of birth:

09/16/2009

GetPRC

John 00.
Smlttl

Your SOcial Security number: 743·7s.4941
, Your date of birth
September 10. 1982

"this information is correct, select "Confirm"
It'this information is incorrect, selecr "Change Your Information" to go back
end cOITectit

09/16/2009

GetPRC

~ Get A Temporary PRC - Confirmation

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Thank you. JOHN DOE. you have successfully requested I€ ternporEllY
Password Request Code (PRC),
It could take aslO/1i as 16 days to ree.lve your PRe I.tter In the mall.
Your PRe is requlfed to create a permanent password When you create your
permanent password, you can access. riMew or change your personal
Intormallon either online or by using our automated telephone saMee.

It other members of your household who receive benefits or peyments would
like a password. they each need to request their own PRe,

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GetPRC

09/16/2009

We WOUld tike to know what you think of this online service. Please take a minute
and complete our survey beloW. II you prefer, }'Queen sldp this SIJMl'j and
;, contlnue onto other tasks

L;·~B.~urmx~a. c]
Wu It eoy to find our
pnlWOrd ..rvle..?

Wu It lOY to undend:and
wMt information you n..ded

OYe.OND

to provide?

WI,.. the Inetructlonl e.ty to
undend:end?

DId we tin you e ..'!')thlng )'0101
n..ded to know about how to
0« 'ptllWOrd?

OVes ONe

Wilit l.tytO U.. our

OVM OND

Will )'OU continue doing
bUllnen with UI onlln, bleed
on your exp,rience today?

Feedback

~you answered "No" to any 01 ltiese questions and neooto ten us more, please
enter your ~ and share your thoughts. Addibonally. please tell us which
coRne servh:;e you were using

pnlWOrd IIrvlee,?

Vel

0 ND

Thank you for respondlngl

GetPRC

09/16/2009

The Privacy Act reQUIres us to notify you that we are autI101ized to collect Itlis
information by seCtion 702 of the Social Secunty Act You do not have to prOYlde
the information requested HO_f, the data you pfOYlde wiU alloW the SOCial
Security Administration to ImprOlie our web site design and better serve you in the
future. This SIJIVey is complemly anonymous
PiperWOI1( Reduction Act

This information coDection meets the clearance 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 va~d Office of Management
and Budget (OMS) control number. We estimate that it will take about 3 minutes to
read the instructions, gather the tacts, and answer the questions. You may send
comments on our lime estimate abOlie to: SSA, 6401 Security Blvd. Baltimore, MD
21235.6401. Send only comm.nt. mating to our time ntlmate to this
eddr•••• not the completed form,
The OMB control nurnberfor Itlis password services application is 0960-0632;
expiration date 1013112000.

If you n..d Immechte

..ellltane.:

You can cal us Monday through Friday: 7.00 AM - 7:00 PM at
HJOO-m·1213

nyou are deaf or hard-ol.healing. cali our loll-free TTY nUmber.
1-800-326.0778
If you need to vld your local

You can get directions and a map to your local Social Security office by'llsiting the

Social Security ollie.:

FleJd Office Locator.

If you .,.. out,lde the UnIted

contact your nearest SOCial Security office. or US. ErtlbasS)! or Consulate. or the
Veterans Aff!l!rs Regional Office fYAROl in !he Philippines

Stilt••:

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GetPRC

09/16/2009

It could take .. long .. 16 days to reeelve your PRe In the mall after
you:
• Request II temporal'\' Password Request Code (PRC). or
• Receive your benefit award notice lif you said yes when asked about
getting II password)
P..... welt IIlleaet 16 days and retum when you have I'ecemd your PRe

lettec

You may can us Monday through Friday; 7:00 AM - 700 PM at

1-800·m·1213
If you 6(6 deaf or hard-of.hearing, call our toll-free TIY number:

1-800-326..0778

GetPRC

09/16/2009

«you WQuld like to request another PRe, please contact Social Securitj and
speak with a representative,

You may call us Monday through Friday 700 AM- 7:00PM at
1«10·712-1213
If you are deaf or hard-of.hearing, cab our toll·free TIY number

141OO-32.6.ona

GetPRC

09/16/2009

We are sorry but thiS service is not available to you. Pl$ase contact Social
. Secunty and speak With a representative
Select "Return to Online SeMces'! for other things you may be able to do.
Selact "Log Out" if YOU are done
You may caH us Monday through Fnday: 7:00 AM· 700 PM at
1-800·772·1213
If you are deal or hard.O/.heanng. tall our toMree

1-800.326,(J7'78
.~

number:

You can get diractlons and a map to your local Social SecuriIY office by visiting
the Field Office Locator.
Contact your nearest Social SecurlIY office, or US Embassy or CoosuIate. or
the Veterans Affairs Regional Office (yARQ) in the PMippmes

.Rerumii@L~f .

GetPRC

09/16/2009

w. Are Unable To Process Your Request At This
Time
We are sony for ltIe inconvenience, but we cannot process your request at Itlis
nme

wyou still wish to make your request, you may tl)' again later or contact a Social
Security representative
You may call us Monday ltIrough Fnday: 7"00 AM· 7:00 PM at

1.soo·m·1213
It you are deaf or hard-of-hearing, can our toll-free m number
1.800-326.om
You can get directions and a map to your local Social Security office by visiting
ltIe field Qf1tce Lo~
Contact your nearest Soci al Security office, or U S EmbasS'j or Consulate or

the Veterans Affairs ROO Qoal Office rYAROl in the pbitipPloeS

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09/16/2009

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Acknowledgement For Online Services
~ANTToUCM'vse this webSite to gain acceestoyour personal -~~-'I
Iinformallon. If you are aellng on beh&lf of anolller person, or if you are a
Ii
If(Eijlresentetive Payee. YOU. cannot use IIlls online seMce and should contacts,

J~~. ~~~~~[~~!!~" ..~...,..~,._.,............ __....... ,....~...,~~ __.J

Arti person who knowingty and willingty makes any rapresentetiOO
1 that is false to obtain information from Social Security records, and/or
2. that is il1t$nded to dec$lVe 1Il$ SoCial Security Administration as to IIle true
idenlltyofllle indMdual,
COUld be punished by a fine or imprisQ!1ment. or bolll. The OMS control number
for this form is 0960-0632; elq:)iratioil date 1013112009.

Ihave reid and agreed to the above eWtmentl am ttl. individUal Who..
personal information Iam requ.stlng,

mil

You may call us Monday' through Friday, 7: 00 AM,. 7;00 PM at

1-800·712·1213
If you are deaf Of hard-of·hearing, caP our tol~lrae TrY number
1«JO.32I..()778

09/16/2009

~ About Password Services
$ociel Security provi des this website for your convenience .

• This website can be used to get a password for online and automated
telephone seMce access to your personal account, If you .... a
I'Ip,...ntatiYl pay.. for another persolJ you cannot get III password to
access their Informatlon
• For security reasons, there are time Omits fOr vour work on each page. You
VoiH receive awarning alter 25 minutes, and you WIll be ab~. to Mend your
lime .on the page. Alter ttle third warning on a pagl). you must move to
another page or your tlme win run out and your wt)rkon that page Voill be
10$1:, It you heve tumed JavaScnpt off in your brOWSer•.you wiU not fflCeive
these werning" After spending 30 minutes on a page. you must mCM) to
another page Of you Will 00 logged oul,

Do not use the Back button on your bro..... to mon backward. u.e thl
Prior Page button Inetnd.
Do notus. the Entarkey to mewe around In the form. u.etha Continue

button Inetnd.

SpeclallnWl.!c!jQllS tor

Pea Who Are Blind

"'.Pt1V_Actstlt.~~,~

SOCIal Security Is allowed It,) collect ttlafacts on this torm undar$ecI'lon 205 of
, ttIa Social Security Act We need lhese facts to qUlckf;identlfy who you ere and
"",., "'.", provldathe informatlon you requested. GiVing us thasQ facts IsvolUi1tlllY,
See Revised Privacy Act Statement Attached
However, wilhaul them we may not 00 able to give you the inrormation·ltlst you
';" "
want The Social Secunty administration will not usa the informatlQll ror art!
'~"'''' oth&r purpose

~11c:.R'~'C!~

This information collection meets the clearance reqUirements of44 US.C §
:c 3507, as amended by seCllon 2 Oflhe Paperwork ReducUon Act ot1996,
You do not n99d to answer these questlons unless we display a va~d Office Of
Management and Budget (OMB) control numoor. The OMB control number for
this form is 09{!0-0632; elq)iratlon data 1013112009, WeesnmatethalitwiPta1<9
about 2 ~ minutes to read the instructions, gather Ihe necessary facts, and
answer Ihe Questions You may send comments on our time estimate to: SSA,
6401 Security Blvd, Baltimore, MD 21235-6401, Send only commentll on our
time ellimate to thie Iddl'lli. not the complated form.

09/16/2009

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Social Sl'curit,\ ( )n lint' .seniCt'S

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Password Services
The Social Security AdminUi\l'ation can issue:you Ii permanent ~rd to
access,te\'1ew or change your personal i~on erther ootine or by using our
automated telephone seMce.

Requntlng end creating I perman.nt pllftWOrd Involv•• 13 ltap
proc....
And said "Yes" when asked about getting a password, Skip step 1. We \"Iill
automatically mail you a temporaiy Password Request COde (PRe) Jetter

You need to get • t.mponuy PIIsword R.qu•• Cod.
{PRC} which \"lift be mailed to the address we h8\l1ll on record for
you. Your PRe will be used to create your permanent password

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step 2:

Wait to receive your PRe letter in the mail. It could tak. u long
u 16 days to rec.lY. your PRC, after you request it, or after
you receive your benefits award notice (if you recently flied for
benefits).

Step 3:

Create your permlnenl plSsword by providing addi~onal
information and using your PRe< v.tlich you r6C9tved in !he maii.

l.v 9l;5!ltYQW_IlIl~E'J!.$~
You ere nmlted to three PRC requeats per yew.
If you know your current permanent password, you can change it here. If you
have forgotten it you must get a new PRe.

~VlV:!3~ ..

Selecting "Block ElectroniC Access" wil block all online and automated
telephone service access to your personal information.

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09/16/2009

Pl•••• proYld.1ttt foRowing information:

r
First name; middle Imbal, if any: last
name, Suffix, if arry

other lut name:
For example, your name as shO'>"Q!

l,d"iH

mlty'J/lV

~ We Are Unable To Process Your Request

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We are SQf!Y but this service is no! available to you. Please contactSocjal
Securny and speak with a rapresenta!lYEt
Select "Return to Ooone Services" for otharthings you miJII be able to d(t

Select "log Our' it you are done.
You may cal! us Monday through Friday 700 AM - 700 PM at:

1-800·172·1213
If you are deaf or hard-of-hearing. eaU our tol~free m number:
1-800..3264178

If you

.,ted .~o YI'~ Vout'~"

SOChIl_CUr!tvOftlcl:

IfYo~.rt OUttIde.tI)l U~

stltaa:

You can get directions and a map to your Iota! Sociai Security office by VIsiting

." the Field OlIice LOC!)tQ(

Contact your nearest Social Security office, or !,.I S Ernblil$SYor Cpn:oylaU!, or
the Veterans Affairs ReQm"!!!1 Office NARC) !D!he PblUPQioas

~jlQtl!!M§~!'i§i.

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09/16/2009

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You can get direc1lons and a map to your local Sodal Security office by'¥isiting
the Ejeld Office Locl.it!X.
Contact your nearest Social Se¢l.I!il.y office. or US Embassy or Consulate or

the Veterans Mairs Regional Olfict(VARQl!D the PblPppilJilil
(.

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09/16/2009

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Social Security ()nline Sl'lyit'l'S

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Your PRe Has Been Suspended
We are sorry for Ihe !ntol'MMlience W we aI"e unable to process your NlQUest.
Please contact Sodal S9culity and speak with a representative.

ThIs do•• not wtrectyour ben.lb.
If you need 1mii!!Jd1at1

~~c.:

You may call us Mondaylhrough Flidav 7.00 AM· 7:00 PM at
1""''172-1213
~ you

are deaf or hafd..of-heanng, call our tol~lree TfYoumber:

1-800-325.(J778
IfYOUn.ed.~';I.ltyour!i~!II; You can get directions and a map to your lo<:al Social Seculity office by \lis/ting
8ocl11ll"cui'ItY ot'/fcj".~.> the EItld Qffl~ Locator
Contact your ~ Social Seculity oflic;e. or!,J S E:!rJbas~ Qf CQos_ or
th9 Veterans A1'fl1IIi B!l!giooal Offlce (yAROl jn thi·f!Ji!lpj)lnes

L_~mlt)?§,lM!ces

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09/16/2009

Sodal Sel'urily (mHne Senicl's

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~ Your Temporary Password Request Code (PRC)

\.Ii Has Expired

Ifyw wish to use a pas~ to access YO\lr pEjrsona! infoonatioo, you rreed to
request a new temporary Pas!IWOfd Request Code' {pRe}. When you receive
ywr PRe tetter. pl$asa create your permanent password before the e>:pirallon
. date in the letter.

You may call us Monday through Friday. 7:00 AM - 7:00 PM at:
1«10·772-1213
~ you

are deef.or Ilard.of~haaring, call our toll.fr~ 1lY number:
1.aoo~

09/16/2009

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Sodal Seemity \ >nline Scn1ct's

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Your Permanent Password Has Already Been
Created
We alread)' have a passworcl on file for you to i'lCC$ss your personal information
If you havalost or forgotten your password, you neQd to get a new tempora!Y
Password Request Cod9 (PRe).

If~..,,,,,,ad IpIJ'I!.dltU
...latlncr: .
,

You may call us Monday Ihrough Friday 700 AM. 7:00 PM at

1«lO-rn·1213
Wyou are deaf or hard-of.hearing, call ourtoll-!ree TTY number:

1«lO-326-0778

09/16/2009

Change Password

Entfr Your Soc~:SitCuiiY

number:

Enter numbers without dashes, tor
example, 123456789

Entfr your password:

Change Password

09/16/2009

JEREMY L TJ1'US. you are curre~ logged in to do business WIth Social
Security onlne. For your secunty. please log out and elo.e sliintemit
Windows wilen you are finished.

While you .... lolKI.d In. the following ••rvlcs..... Iyllllible:
Chock your benefits and InfQl'!Il!3!iOO You can see the contact. direct deposit.
Medicare and payment information we have lor you.
Change your add{§ss or teleplJone number
ReQu!klst or change your direct deposit
Change your pasS't'l'9l'd
By providing addltlonlllnformatlon, the following

nrvIcs.....

SYsIlable:
Get a replacement Medicare card You can request a replacement card onhne
and receive It in about 30 days.
ReQuest a Proof of Income leiter You can request a letter thai verifies your
SoC) al Security Information and receive It In about 10 days
Block electrotlic access to your persona! jnfQrmaIJon You can block all online
and automated telephone access to your Social SeCUflty personal info/'m8tjon.
For your securlty. please log out and closs sIIlntemetwindows when you
arelinished

09/16/2009

Change Password

Change Your Permanent Password - Choose Your
New Password
ChOOS4 a new 7 digit password. Use 1 numbers that are meaningful to you to
help yoo remember.

Helpful Hlnta for Chao.n; a PHsword:
.. Use 7 numbers only.
.. Use a number that is meaningful to yoIl so that you will remember it.
Do NOT dIootte • p••sword containing:
~P\'lrt of your Social Secwity number;

.. a sen as of numbers that~old beeasy to guess: 1234567 or 7654321;

• a series of the same numbers: 2222222 or 3333333; or
• your temporary Password Request Code (PRe).

Do NOT use • password others might ...oclate with your:

..
..
..
..

telephone number,
birthday or your child's birthday,
iicense plate number, or
streat Ilddress number orzip code

Enter your new permanent

pauword:
Enter your new permanent

PHswon:I ag.n:

09/16/2009

Change Password

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S( )Cia 1SecU ri Iy ( }nli nl~ Services

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Change Your Permanent Password - Confirmation

You have successfully changed your pannan9nt password for your Soci al

S$Curii¥ account

Your ,u8WOrd Is the key to your ,el1lonallnformatlon. Guald it .;9refully

• Do NOT put it v.i1ere others tan ~ it

• Do NOT store it with other personal information, like your Sooal Sacurn.y
number.

• Do NOT give it to anyone else
SocII! Security M1pIope. wiU never uk for your ,u.word.
With II permanent password, you can nwiew or change your irtOfmation either
on_ne Of by using our automated telephone seNice.

•

/IX

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09/16/2009

.
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I."" iN nU, l.}b

Social Securit~" ( )nJine Ser\ices

Hnty>!"....

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The Pnvacy Act requl res us to notify you that we are authorized to coll$(;t II1i s

IIlformation by section 702 of the Social Security Act You do not have to prOVIde

the information requested However, the data you provide win alloW the Social

Security Administration to Improve our web site design and better sell/$ you in the

future. This survey IS completety anonymous.

Paperwork Reduction Act

This information coRection meats the clearance reqlllrements of44 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 vald Office 01 Management
and Budget (OMB) control number. We estimate that it will take about 3 minutes to
read the InstrudJons, 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 comment. relating to our time eatlmate to this
add,..., not the completedfonn,
The OMS control number for this password seMces appficetion is 0960-0632;
expiration date 10131/2009.

If you nead Immediate

a..latanl:e:

You can call us Monday through Friday: 700 AM - 700 PM at
1.1101).772.1213
nyou are deaf or hard-ot-hearing, caR our tol~fi'ee TTY number.
1.aoo~.0778

If you need to ylslt your local
SOCial Security omce:

You can QI'>t directions and a map to your local Social Security office by visiting the
Field Office Locator

If you are outside tM United
Stat..:

COOtact your nearest SOCial Security office, or U S EmbaSSY or Consulate or the
Veterans Aflairs ReQional Office !VAROl in the Phjliopioos

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:.<-:.. .~. . ':..
S')'l,lIS,<, Hilt: ')nlul('
y..;;..r Ns\.tt,.I".(lu!f'f(!()V

Social Seeurity t mline Sen ices

We Ate Unable To Process Your Request

'!r:.J

We are sony for the inconw.nlence, but we cannot match the Information you
have prOVIded with our records.
If the information you have provided IS correct, then it may be necessary to
contact a Social Security representative and correct your Social Security record.

need immediate
...,ltanee:

If you

You may call us Monday through Fnday 700 AM· 7:00 PM at

UIOO·m·1213
If you are deaf or hard-of.heanng, call ourtol~free TTY number:

1-800-326..0T78
If you need toVl.lI; your IOcll

Socl«l S.cur1ty oft'Ic.:
If you nout,lrJ. the Unftta

stlt.,:

You can get directions and a map to your local Social Security office by visiting
the Field OffiCE! Locator
Contact your nearest SOCial Security office, or U S EmbasS)' Qf Consulate, or
ll1e veterans Affairs Regional OflJce (yAROI in !he PhfiiPJIlnes

09/16/2009

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o
S,,, laIS('''lI!!;f)nIUl('
W:N¢i \Ut

Sodal Security ( mlinc Scnices

Mf"·'llIltY~MV

We Are Unable To Process Your Request
We 6fe sony but this seMceis not available 10 you. Please contact Social

sacUl'll\' and speakw1th a representative,

Select "Return to Online Services" for otllertllings you rn
ablE> to see or changE> your personal information online or by USing our
automated telephone SE>MCe
If you decide you want electronic access tn the future, you Will need to contact

Social SecUlily,

To bloc:k electronic: ac:c:e•• to your peraonm Information, select
"Contlnu" ,"

:)')(1,,[5.,. lIllt' (Jul.lh'
h'l,,,,* ~

Social Security ( )nline Services

"I.lI"O;t, l\<;N ~

S( )dal Sel'uril:-. ( )nline SeI\'ices

tll-., tln1\! q''',.'

Information We Need
Pl•••• provld. the following Information:
Enter your Socl., Securtly
numb.r~

r~m~~~~'

.. ".'m\

l_._________.J

Enter numbers without dashes. ror
e)(ample. 123456769
SelectyourdOlta of birth:

~"('Hh,'( lIllll (!lIitlll'
-/Ii'b'oN

COMU1""

S( ldal Sl'('Urity ( )n line Scnil't'S

"1111..,,, IUftV'11LI

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l
Are you lure you wsnt to bloc:k aU electronic: ac:c:e•• to your personal
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"you decide you want electronic access in the future. you Will need to contact
Social Security.
No, 00 Not Block EledronicAccess.

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09/16/2009

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<-;;llillingly makes any representation
1 that is false to obtain information from Social Security records. and/or
2. that is intended to deceive the Social Security Administration as to the true
identity of the individual,
could be punished by a fine or imprisonment, or both. The OMB control number
for this form is 0960-0632; expiration date 1013112009
Ihive reid and lllra.d to th.lbove ltatement lam the Indlvldull who..
personllinfonnatlon lam raquestlng.

~
~
If you nnd Imm.dlet.

Dslatance:

You maycaU us Monday through Frtday: 7:00 AM- 7:00 PM at
1.aoo.772·1213
If you are deaf or hard-of-heanng. call our tOIl-free TTY number:
1.aoo.326.o718
Nocd Larger Text?

""»N''',.

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Log On for Access to Password-Protected Applications

SPII.llSNUUh.
'f'.~i~ ".'ill,ll,,'

)nbn~

Social Security ( )nline Senices

'Wlry,l Y"

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example, 123456789

Enter your pUlWOrd:

09/16/2009
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09/16/2009

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S,>ClllSe'U1Il\(milll.'
~"":.'¥...,,.,

Chl'ck Your Benefil,,>

t)is' ,Hlttlftjir""

ti; About Check Your Benefits
'!"V
Sod11.11 Security provi des this website for your cooveoieoce..
• This web site can be- used to Cha-ck Your BeneftlS.lfyou are a
repruentdv, P4IYM for another person you cannot access their
information.
• For s6Cl.lril¥ reasons. there are lime limits for your work on each page You
will ~celW awarning alter 25 minutes, and you will be able to elt.tend your
time on the page. After the third warning on a page. you mustlllO\l&to
another page or your tilThlwili run out, and your work on that page ~ Nbe
lost If you h8\l$tumad your JavaSCl1pt off in your browser, you WIll not
r~~ these wamings. Mer spending 30 mi/lutes on iii page, VOU must
move to another page Qr you will be logged out

00 not Ute the Back Button on your browurto move backwlnl. U•• tne
Prior pege button 1ruItead,

00 not U.I til, Enter key to move around In tile form. Uti till ContInue
button Imte.d .

•~~~~~~~~~!;ft~~;

S!)ecja! Instructions for!?eom Who Am Blind
This information coDeetion meets the clearante requirements of 44 U.s.C. §
35lJ1. as amended by section 2 of the Papll'WOliI Reductton Act of 1996.
You do nOI need 10 answer these questions lInless we display a Vi:lUd Office of
Management and Budget (OMS) control nlJl'llber. The OMS control number for
this form is 0960.0632; expiration date 1013112009. We estimate that itwiU tli~
about 1 '1.0 minutes to read the instructions, gather the necessary facts, and
answer the questions. You. may send commenlsonour time estimate abCl\le to:
SSA,6401 SeCUrity Blvd, Baltimore, MD 21235-6401. Send only c:omment:l
on our tlmlfttlmate to till. add,.••• not tile eomplated f'onn.

Check Your Benefits

09/16/2009

Check Your Benefits

~;..(,,~J

Welcome. This website allows you to see your basic benefit Information for
Sodal Sacunty and.SlJpplamemal Security Income (SSI). Select arTY oftha
choices below to see your current informatton accordmg to SOCial Sacunw and
55! records,

SeIRt ~ ~~

woUld like to ...~

;:t

,:;

Your name, date of birth, current address, telephone number and local Social
Securtw olfi.;:s·

Your direct ooposit and financial mSUtlJ~on information'

Direct DeRgf! Inform4\tiM

VourMedicara, Part A, Part B, Medicare AdVantage and Prescripbon Drug
Coverageinformebon

Your benefit WPe, payment amount and wMo your payments are made:

The total amount of any overpayment and your monthly withholding:

[

For other tnm.actlona:

~rem~I!l!9"Wlt!.liQn

For other tTansacbonsorto make changes tayour record, you can return to
Qnljne~.

~L~o!ill

09/16/2009

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S"c"II'),>v

(

'heek Your Benefit",

"Wf1"WiiFf,,·""'·W.'··.""ii
Your Identification and Contact Information

If you have recantly changed your Information, It may take several days
for chana.. to appear on this _b sits.

Our Social Sec;urlty rec:onle
show:

Your full name is.

JOSEPH N HART

Your date of birth IS:

March 11, 1917

Your current mailing address is:

JOSEPH N HART
RT1 BOX 162

HEARNETX
77869 ·9711

If you would like to mike
c:hanaae to the informaflon _

Your current telephone number is:

(409) 279 ·6910

Your local Social Security olli ce IS
located at:

SOCIAL SECURITY

You can change your Social Security mailing address andlor phone number
online by selecting.

r---iii~.:':I:\Il::!!:':iI"::'Ac:I-:::d::::l'iI:':ss::-'I!Ill=#:::Qt:-;:PI\:ro::n!':"iIN:':.UI!Ibe=':':r:---"

are showtna:
If you nlld IfI'Im,dlata

, ..Istance:

You may call us Mondaylhrough Friday: 7:00 AM· 7:00 PM at

1«JO.772·1213
Wyou

are deaf or hard-of.heanng. call our toll·free m number:

1-800-326-4778
If you need to vilit your local
Soc:111 Sicurity ottIce:

You can get directions and a map to your local Social Security office by visiting
the Field Office Locator.
Rs1um 10 CIted!'Hnh \ lnitw'

(~hcck Your

Bcnetils

..",,,,'I; ". ,( !<"tl"·;f (III It.. Wf"';

Your Direct Deposit and Financial Institution

Information
If you haYe ree.ntty changed your Informallon, It may take ••vera! daye
for changn to IPpe.,. on thll web lite.

aUf I!I~M"CUtttv I1II.Cd

.~Y0··

Yoor Social Security payment goes to:

FIRST VICTORIA NAllONAL
BANK

The routing number is:

111903818

For aecurfty reuons we only show

number.

lilt .. dlglte ofyour' account

The. last .4 digits of your ac<;ount number 78.7

are:

Checking

2ih\i)c1ii 'four account type is:

IfVOUVW@ financial institution information online by selecting

.r. .howlll9: ,'....".......

If VOfi;~lf !IMt.t:!~<.

...lttanc.:

" , 1••

You mayeall tlsMondaythroughFnday: 7:00AM· 700 PM at:
1-800·772·1218
f you are deaf or hard-ol·h$aring. call. our toll-free TIY number:
1.&00.325..0778

6')

Check Your Benefits

09/16/2009

.. " .

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Ii*'I,e,·"·'.,,·';eiiii'·.""""
Your Medicare Entitlement and Premium

Infonnation

If you have recintly changed your Infomudlon, It meyteke elYlreI daya
for changl. to IPpNr on thllMb lite.

MMlcare HOlpltlllnlurance

(Pm AI information:..

You receive MedIcare Part A (hotpllallneurence) boed on your egl.

You became entitled to Part A
March 1982

beginning:

You recelYe MedIcare Part B (medlclllntUrenct) balld on your egl.
You became entitled to Part B
March 1982
beginning:
Your currant monthly premium for Part B $ 93.50
is
The elfeCllve date for ltIi s Part B
October 2007
premIum amount IS.

If youlollt.Votll" Mldicare cri: You can request a new Medicare card online by selecting:
j:l~Mt,di~ Rep~menlGard

1fVC*.n"~~11I verll'k:«thln
ofyOur"arelnfonnltlon:
,

"'\

You can request an official verifiq'loon of your entitlement information. P¥1ent

amount, and MediCare information onDne Whlctrwlll be mailed to Yoll.in 1 to

10 daYS. by Selecting:

Qpl Proof oIlncomeb!j!!lr

You may caQ us Monday through Fnday: 1;00 AM - 7:00 PM at

1.aoo·m·1213

It you Me deaf or hard·of-hearing. call our toll-free m nl.llTiber:
1.a00.326.ar78
.~ 10 ChaQ<,.),P,II! ad

\i~

09/16/2009

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•

:nft'ldl S(,"lIlt\< minI!'

(

"'heck You r BenC'flt..,

'hWW !tl,' Idb.· 1 Hffl~ il'N

Retirement
Your regUlar monthlY payments ere mada3rd Wedneedey of the month
on the'
" Your O11'TE!nt month's benefit amount js: $1227.60
.• This amount does not inclUde any deductions you have, such as Medfcare
Premiums or payments on money you owe us (OVerpayments).

. The lest year of work you reported was: 1981
C.- Gf LMng ~ultinenb:

Your Social Secunty benefit goes up each year along v.lth the cost otlMng. To
check the new Cost of UVing Adjustments. Vlslt SOCial Security Chengas.

If you need otJIclel verlftc.rtton. You can request an official veriflcailon ofyourentitiament information, payment
of your ben.tfIt IntormIil1ow.·· amount, and Medicare information onlne ~ich Will be mailed to you Within 7 to
10 days, by selecting:

If you need in'Imedllte

•••hltencl:

You may call us Monday through Friday: 7:00 AMw 7:00 PM at
1-800.772-1213
If you ere deaf or hard-of.hearing, caU our tojJ.free TIY number
1.a00.326..oT18

If you need to vllit your local
Soclel Security oIIIee:

You c8ngQtdirections and a map to your local Social Securityofm:e byvisiling
the Fjeld OIIke Locator

09/16/2009

Check Your Benefits

S"q,tlS('''lH!:J)nllih'

'heek Your Benefits

'hWi!~ '>,.. ..il". ~ lit ltv \I'W

"9"'fi!'" e'-WE

•""-.'9&

Your Overpayment Information

Ou,iOci!lll s.curtty reco~!,~~" You do not owe Social S,curlty any money for. Socia' s.curIty
,how:

'" OV.rpaym.nt.

:::=Jl~;~'"

You may call us Mond,=~g~i~ 100 AM- 1.00 PM at
"you are deaf or har~-t'learing, call our toll-treQ TTY number:
1«10-326.0718

1f"~\I'I..#tl)vI~_totlil

,~S'Cg~~:

Vou can gat dlfections ~a map to your local SoCial Security oIflCe bylliSiting
the Fjeld OfIlce Lo.cetor.

Check Your Benefits

\'J<13I S ""l!tI}I)nilllC'
,",Nit.

"',< <'Ih. t Hflty it

09/16/2009

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'" You Are Leaving Check Your Benefits
You have chosen to go to Change Addrtll andtor Phone Number. 'Mien
voo have COmpleted other salVi eEls onIlM < you will Med to S$lect Check Your
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Arry thang.. you 1Mb to your Infomllllion maytakt ••veral d . for
c:han"e. to ap"... on thI8 Web IItt.
lfVOO want to gO to Change Addre.n MdtQr Phone Number. select
·Contlnue".
Wyou do notwant to leave Check Your Benefits, sellllct "Prior Page"

PriQ,fl4ge

CQlllirm

09/16/2009

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The follQWlng instructions are for screen reader users like JAWS and WlIl'"

j,d

('heek Your Bent't1L<.;

,! lIilf\! q IV

We Cannot Process Your Request at this Time
We are sorry for the inc~ence, but we cannot process your request at this
nme. 11 you wiSh to make your request, you mft{ l!y ElgElin lEIter.
You mEl'( call us Mondaylhrough Friday 7:00 AM· 7:00 PM at

1.aoG·712·1213
~ you

are OOaf or hard-of-hearing, call our toll-free TTY number:
1.aoG.325~

m·i;.•·. :.•·. .•·. .·•. ·. .;j•.~. ,._ ~ "

09/16/2009

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SiHklISertHlt\i)llllih'
WIN IN

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('heck Your Benefit..,

fdi9 t W Ity {lIN

his Service Is Not Available AI. This Time

Monday through Fnday S:OO AM - 100 AM
Saturday: 500 AM· 11:00 PM
Sunday 8:00 AM· 10:00 PM
Holidays"" 5;00 AM- 1tOO PM

09/16/2009

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09/16/2009

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o
Sq",lISc'dHll\{)nuw
WWltl

til.,.

(hfltv fl<:ro!

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'l1l'ek Your Bl'ndib

We Are Unable To Process Your Request

\'/,,,J;I

We are sorry but ttlis seMee i5.l1ot available to you PleaS$ contact Social
SecUi1ty and speak with a rapr~ntalive
Select "Return to online Services" for otherthiOQs you may be able to do.
Select "Log Out" it you are done.

You may call us Monde{ through Friday: 700 AM - 700 PM at

1..900·772·1213
If you are dear or hard-of.hearing, cail our toMree TTY number.

f~ liNd to~i~lt your l~.
·1oehII ~r;tyol'l'k:.:
.. ....

1..&00-3254711
. You can g'llt directions 8nd a map to your local Sodal Security office by IlisltiOQ
the Field Qffi<;e Locator
If you ave outside the .United Stales, S$E'l SeM<:9 Around me Wodd

§iilg Qn.ne S(l~

•

~='.J

SSA will insert the following revised Privacy Act Statement to the RISPA screens upon
approval of the ICR:
Privacy Act Statement
Section 205, of the Social Security Act, as amended, authorizes us to collect this
information. The information is needed to quickly ascertain and verify identity and to
provide you with the requested information. Providing this information is voluntary.
However, failure to provide all or part of the requested information may prevent the
Social Security Administration (SSA) from providing you with the requested
information.
We rarely use the information you supply for any purpose other than for ascertaining and
verifying identity in order to provide you with requested information. 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: (1) to enable a third party or an agency
to assist Social Security in establishing rights to Social Security benefits and/or coverage;
(2) to comply with Federal laws requiring the release of information from Social Security
records (e.g., to the Government Accountability Office and Department of Veteran
Affairs); (3) to make determinations for eligibility in similar health and income
maintenance programs at the Federal, State, and local level; (4) to appropriate Federal,
State and local agencies, entities and persons if there has been a breach of security to this
system that would result in the a risk of harm to economic or property interests, identity
theft or fraud or harm to the security or integrity of other SSA systems and such a
disclosure is necessary to respond to the breach; and (5) to facilitate statistical research,
audit or investigative 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 and administered benefit
programs and for repayment of payments or delinquent debts under these programs.
A complete list of routine uses for this information is available in Systems of Record
Notice 60-0290. The notice, additional information regarding this application , and
information regarding our programs and systems, are available on-line at
www.socialsecurity.gov or at your local Social Security office.

File Type	application/pdf
File Modified	2009-09-24
File Created	2009-09-17