Social Security Medicare Application Online

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https://secure.ssa.gov/acu/ophandler/defaultLogin?URL=/apps6a/i1020/main.html

Acknowledgement for Website Access

I understand that the Social Security Administration will validate the

information I provide against the information in Social Security

Administration's systems.

I certify that:

a.. I understand that I may be subject to penalties if I submit fraudulent

information.

b.. I agree that I am responsible for all actions taken with my User ID.

c.. I am aware that any person who knowingly and willfully makes any

representation to falsely obtain information from Social Security records and/or

intends to deceive the Social Security Administration as to the true identity of

an individual could be punished by a fine or imprisonment, or both.

d.. I am authorized to do business under this User ID.

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By entering your User ID, Password and clicking on the " Login " button, you

certify that you have read, understand and agree to the above statements.

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If you received this page unexpectedly while using Online Services for a

personal account, please call our toll-free number 1-800-772-1213 (TTY

1-800-325-0778) or visit your local office

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Information about socialsecurity's Online Policies

The privacy of our customers has always been of utmost importance to the

Social Security Administration. Our first regulation, published in 1937, was

written and published to ensure your privacy. Our concern for your privacy is no

different in the electronic age.

a.. Details of socialsecurity's Online Privacy Policy

b.. Details of socialsecurity's Online Security Policy

c.. The Privacy Act and The Freedom of Information Act

d.. Paperwork Reduction Statement

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