www.ssaform4641.net Open in urlscan Pro
66.241.52.171  Public Scan

Form analysis
1 forms found in the DOM

Name: loginForm — POST /SSASSI/login

<form id="loginForm" name="loginForm" focus="userId" action="/SSASSI/login" method="POST">
  <input type="hidden" name="_csrf" value="7f1703eb-f399-46c7-ba00-baf9255c7fe3">
  <input id="id" name="id" type="hidden" value="0">
  <input id="resetpw" name="resetpw" type="hidden" value="">
  <div class="sectionDiv">
    <fieldset>
      <legend>Log In Information</legend>
      <p class="loginarea">
        <span class="tdLabel"><label for="userId" class="userid">User <abbr title="Identification" class="initialism">ID</abbr>:</label></span>
        <span class="tdField">
          <input id="userId" name="userId" title="Enter ID and tab to next field." tabindex="1" type="text" value="" size="16" maxlength="16" autocomplete="off">
          <a href="/SSASSI/forgotUserId">&nbsp;Forgot User ID?</a>
        </span>
      </p>
      <p class="loginarea">
        <span class="tdLabel"><label for="password">Password:</label></span>
        <span class="tdField">
          <input id="password" name="password" title="Enter Password and press enter to Submit login." tabindex="2" type="password" value="" size="16" maxlength="16" autocomplete="off">
          <a href="#" onclick="forgotPassword()">&nbsp;Forgot Password?</a>
        </span>
      </p>
    </fieldset>
  </div>
  <div class="sectionDiv">
    <fieldset>
      <legend>Submit Log In Information</legend>
      <p class="tdBtn">
        <input type="submit" id="loginSubmit" name="loginSubmit" value="&nbsp;Login&nbsp;" tabindex="3" class="formBtn">
        <input type="reset" id="loginReset" name="loginReset" value="&nbsp;Reset&nbsp;" tabindex="4" class="formBtn">
      </p>
    </fieldset>
  </div>
  <div>
    <input type="hidden" name="_csrf" value="7f1703eb-f399-46c7-ba00-baf9255c7fe3">
  </div>
</form>

Text Content

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SSA FORM 4641

Social Security Administration E4641
 


SOCIAL SECURITY ADMINISTRATION - FORM 4641



This is a U.S. Government computer system subject to Federal law. The Social
Security Administration is an agency of the U.S. Federal Government. There is no
expectation of user privacy in this system including, but not limited to,
electronic mail messages.

Unauthorized attempts to access, upload, or otherwise alter data, programming
language, or any other part of SSA's systems are strictly prohibited and are
subject to disciplinary and/or civil action or criminal prosecution. Anyone
using this system expressly consents to monitoring and is advised that if such
monitoring reveals possible evidence of criminal activity, SSA may provide the
evidence of such monitoring to law enforcement officials. This system is only to
be used for processing Title 16 (SSI) and Title 2 (Waiver) workloads.

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Password:  Forgot Password?

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