ACU Screens with Highlighted Revisions

Attachment B: ACU Screens with Highlighted Revisions

06/28/2010

Social Security Online

Social Security Online Services
www.socialsecurity.gov

Acknowledgement For Online Services
Terms for Use of Online Services
[Screen name changed to: Terms for Use of Online Services]
[We have simplified the language on this page.]
IMPORTANT: [Changed to: ! Use of this Online Service]
You can use this website to gain access to your get 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 directly.
[We changed the order of the text entries. First, we display OMB Clearance language
along with a link to the Paperwork Reduction Act. We spell out the month for OMB
Expiration Date.]
The OMB control number for this form is 0960-0596; expiration date September 30, 2012.
Please select the link below to read about SSA’s legal authority for collecting information.
Paperwork Reduction Act

[Next, we added the link to the Privacy Act Statement for Online Services and framed it.
We also added a check box. User must indicate that s/he read the Privacy Act
Statement.]
____________________________________
Privacy Act Statement for Online Services
Privacy Act Statement
____________________________________
I have read the Privacy Act Statement.
____________________________________

Any person who knowingly and willingly makes any representation that is:
•

that is false to obtain, in order to get information from Social Security our records,
and/or

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Attachment B: ACU Screens with Highlighted Revisions
•

06/28/2010

that is intended to deceive the Social Security Administration (SSA) us as to about 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 help now:
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 | Site Map

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Attachment B: ACU Screens with Highlighted Revisions

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 September 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 B: ACU Screens with Highlighted Revisions

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, M.I. 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 last name as shown on your latest Social Security card.

Mother's Maiden Name: [MMN moved up on the screen to be grouped with the
other name entries.]
Mother's Maiden Name. Last name only ??1 – 20 letters.?, Enter the last name only

Enter Your Social Security number (SSN):
Enter numbers without dashes, for example, 123456789 Enter the numbers with or without
dashes.
Enter your Social Security Number: Enter numbers without dashes, for example, 123456789.

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

Your date of birth. Day.

birth. Year.
4

Your date of

Attachment B: ACU Screens with Highlighted Revisions

06/28/2010

[Day and Year will no longer be drop-down lists. The user will key the day and
year.]

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

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

[User will select “U.S.” or “Other” using a radio button. If “U.S.” is selected, a drop-down
list of states and territories will be displayed for user to select from. If “Other” is
selected, a drop-down list of foreign countries will be displayed for user to select from.]

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

Continue

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Attachment B: ACU Screens with Highlighted Revisions

06/28/2010

Social Security Online Services
www.socialsecurity.gov

Verify Your Information
If this information is correct, select “Continue.” If this information is incorrect, select
“Edit” to go back and correct it.
Edit

About You

Your full name:
John Q Smith Jr
Other last name:
Jones
Your Mother's Maiden Name: Adams
Your date of birth:
January 13, 1962
Your place of birth:
AK
Your Mother's Maiden Name: Adams
[We moved MMN field up on this page to group it with the other name fields.]
If this information is correct, select "Confirm".
If this information is incorrect, select "Change Your Information" to go back and correct it.
[This instructional text has been moved to the top of the page. We changed the
“Confirm” button to “Continue” and the “Change Your Information” button to “Edit.” We
moved the “Edit” button up near the top of the page where it is more visible.]

Exit

Continue

Change Your Information

6

Confirm

Attachment B: ACU Screens with Highlighted Revisions

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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