Current ACU Screens in Production

Attachment A: Current ACU Pages in Production

06/28/2010

Social Security Online

Social Security Online Services
www.socialsecurity.gov

Acknowledgement For Online Services
IMPORTANT: You can use this website to gain access to your personal information. If you are
acting on behalf of another person, or if you are a Representative Payee, you cannot use this
online service and should contact a Social Security representative.
Any person who knowingly and willingly 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 (SSA) as to the true identity of the
individual,
could be punished by a fine or imprisonment, or both.
Please select the link below to read about SSA's legal authority for collecting information.

Paperwork Reduction Act.
I have read and agreed to the above statement. I am the individual whose personal
information I am requesting.
I Agree
Exit

If you need immediate assistance:
You may call us Monday through Friday: 7:00 AM - 7:00 PM at:
1-800-772-1213
If you are deaf or hard-of-hearing, call our toll-free TTY number:
1-800-325-0778
Need Larger Text?
Privacy Policy | Website Policies & Other Important Information l Site Map
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Attachment A: Current ACU Pages in Production

06/28/2010

Social Security Online
Social Security Online Services
www.socialsecurity.gov

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 (OMB) control number. The OMB control
number for this form is 0960-0596; expiration date 09/30/2012. We estimate it will take about 10
minutes to read the instructions, gather the facts, and answer the questions. You may send
comments on our time estimate to SSA, 1338 Annex Building, Baltimore, MD 21235-0001.
Send only comments on our time estimate to this address, not the completed form.
Close this window to return to the application.

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Attachment A: Current ACU Pages in Production

06/28/2010

Social Security Online
Social Security Online Services
www.socialsecurity.gov

Information We Need
Please provide the following information:

Enter your full name:
First name; middle initial, if any; last name; Suffix, if any
Your Full Name. First name; middle initial, if any; last name; Suffix, if any. Enter your first
name.

Enter your middle initial.

Enter your last name.

Enter

your suffix.

Other last name:
For example, your name as shown on a recent letter from Social Security or your maiden name
Enter other last name. For example, your name as shown on a recent letter from Social Security
or your maiden name.

Enter Your Social Security number:
Enter numbers without dashes, for example, 123456789
Enter your Social Security Number: Enter numbers without dashes, for example, 123456789.

Select your date of birth:
Select your date of birth. Month.

Your date of birth. Day.

birth. Year.

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Your date of

Attachment A: Current ACU Pages in Production

Place of birth:
Select state or enter name of foreign country of birth
Place of Birth: Select U.S. State or Territory U.S. State or Territory

Place of Birth: Please enter Foreign Country name Or Foreign Country

Mother's Maiden Name:
Mother's Maiden Name. Last name only 1 – 20 letters. Last name only
Exit
Continue

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06/28/2010

Attachment A: Current ACU Pages in Production

06/28/2010

Social Security Online Services
www.socialsecurity.gov

Verify Your Information
Your full name:
John Q Smith Jr
Other last name:
Jones
Your Social Security number: 743-12-1212
Your date of birth:
January 13, 1962
Your place of birth:
AK
Your Mother's Maiden Name: Adams
If this information is correct, select "Confirm".
If this information is incorrect, select "Change Your Information" to go back and correct it.

[Exit]

[Change Your Information]

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[Confirm]

Attachment A: Current ACU Pages in Production

06/28/2010

(ACU Error Message 016)

Social Security Online Services
www.socialsecurity.gov

Check The Social Security Number You
Entered
We cannot accept the Social Security number that you provided.
Please check this number. If this is your correct Social Security number, contact a Social
Security representative.
Be sure to mention that you tried to use this online service.

If you need immediate assistance:
You may call us Monday through Friday: 7:00 AM - 7:00 PM at:
1-800-772-1213
If you are deaf or hard-of-hearing, call our toll-free TTY number:
1-800-325-0778

If you need to visit your local Social Security office:
You can get directions and a map to your local Social Security office by visiting the Field Office
Locator.

If you are outside the United States:
Contact your nearest Social Security office, or U.S. Embassy or Consulate, or the Veterans
Affairs Regional Office (VARO) in the Philippines.

[Return to Online Services]
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