Electronic Records Express Demo: Modify My Account


Social Security Online	Electronic Records Express
www.socialsecurity.gov	Electronic Records Express Home User Instructions

Name:

John Doe

	Electronic Records Express
	Modify My Account


An asterisk (*) indicates a mandatory field.

User Id:	johndoe

Role:	Individual End-User
Status:	Active

First Name: *	John
Middle Name:
Last Name: *	Doe

Organization Name:
Department:
Position:

Office Phone: *	Ext:
Cell Phone:	Ext:
Fax 1:	Ext:
Fax 2:	Ext:

Primary Email: *
Alternate Email:

Address Line 1: *
Address Line 2:
Address Line 3:
Country: *
City: *
State/Territory:
Zip: *