Attestation Statement for SSA Form 89 Verification
This file contains the attestation statement for using the SSA Form 89 Verification Service. It includes the rules and requirements for accessing the CBSV service. Additionally, it outlines the responsibilities for safeguarding Personal Identifiable Information (PII).
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How do I fill this out?
To fill out this form, you need to provide your company information and acknowledge understanding of all SSA rules for using the CBSV service. Ensure you follow all the requirements listed in the form. Make sure all fields are completed accurately before submission.
How to fill out the Attestation Statement for SSA Form 89 Verification?
1
Provide your company name, address, and EIN.
2
List DBA names which will use SSA form 89.
3
Acknowledge your understanding of the SSA rules for CBSV service.
4
Ensure you comply with the safeguarding of PII as outlined.
5
Sign and date the attestation statement.
Who needs the Attestation Statement for SSA Form 89 Verification?
1
Companies requesting access to the SSA Form 89 Verification Service.
2
Businesses that need to verify Social Security Numbers for their clients.
3
Organizations conducting background checks or pre-employment screenings.
4
Entities seeking compliance with Federal regulations for SSN verification.
5
Companies needing to safeguard Personal Identifiable Information (PII).
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With PrintFriendly, you can easily edit this PDF form. Use our PDF editor to enter your information and make necessary changes. Save and download your edited form for submission.
1
Open the PDF form on PrintFriendly.
2
Use the toolbar to enter your company details.
3
Acknowledge understanding of SSA rules for CBSV service.
4
Fill in all required fields accurately.
5
Save and download your edited form.
What are the instructions for submitting this form?
To submit this form, complete all required fields and ensure accuracy. You can submit it via email to the appropriate SSA contact or through a secure fax number if provided. For online submission, use the designated SSA submission portal. Ensure all PII is safeguarded during the submission process and keep a record of your submission for future reference. My advice is to double-check all entered information for accuracy and compliance with SSA requirements before submitting.
What are the important dates for this form in 2024 and 2025?
Form date: 12-17-2015. Ensure submission before any deadlines mentioned in related company guidelines.
What is the purpose of this form?
The purpose of this form is to request access to the SSA Form 89 Verification Service and outline the responsibilities for using the Consent Based Social Verification Service (CBSV). By completing this form, companies agree to comply with SSA's rules and ensure proper handling of Personal Identifiable Information (PII). Additionally, the form includes the procedures for obtaining valid consent forms and maintaining data security.
Tell me about this form and its components and fields line-by-line.
- 1. Company Name: Enter the name of the company requesting CBSV access.
- 2. Company Address: Provide the complete address of the company.
- 3. Company EIN: Enter the Employer Identification Number of the company.
- 4. DBA Names: List any Doing Business As (DBA) names associated with the company.
- 5. Consent Acknowledgement: Acknowledge understanding and compliance with SSA rules for CBSV service.
- 6. Signature and Date: The responsible individual must sign and date the form.
What happens if I fail to submit this form?
Failure to submit this form may result in denial of access to the SSA Form 89 Verification Service.
- Non-Compliance: Your company may be deemed non-compliant with SSA requirements.
- Service Interruption: The CBSV service provider may suspend access to CBSV services.
- Legal Penalties: Your company may face legal penalties for not adhering to SSA rules.
How do I know when to use this form?
- 1. Access Request: When your company needs access to verify Social Security Numbers using SSA services.
- 2. Consent Compliance: To ensure valid consent forms are obtained from clients.
- 3. PII Safeguarding: When your company needs to outline how Personal Identifiable Information (PII) will be safeguarded.
- 4. Rule Acknowledgment: When acknowledging understanding of SSA rules for CBSV service.
- 5. Data Correction: When submitting corrected data to SSA in case of discrepancies.
Frequently Asked Questions
What is the purpose of the SSA Form 89 Verification?
This form is used to request access to the SSA Form 89 Verification Service and outlines the rules for using CBSV.
How do I fill out this form on PrintFriendly?
Use our PDF editor to enter your company information, acknowledge understanding of SSA rules, and fill all required fields.
Can I sign this form electronically?
Yes, you can use our PDF editor to add your electronic signature to the designated fields.
How do I share my completed form?
Save and download the completed form on PrintFriendly, then share it via email or any other platform.
What information is required on this form?
You need to provide your company details, acknowledge SSA rules, and comply with safeguarding PII requirements.
Who needs to fill out this form?
Companies requesting access to the SSA Form 89 Verification Service and handling PII need to fill out this form.
What should I do if I need to correct the information?
Use our PDF editor to make any necessary corrections before saving and downloading your form.
Is there a cost for resubmission if data discrepancies occur?
Yes, the cost for resubmission will be borne by you if data discrepancies need correction.
Does this form verify employment eligibility?
No, CBSV does not verify employment eligibility or interface with DHS verification systems.
When will I receive a Verification Code?
Each SSN submitted will be returned with a Verification Code indicating if it matches SSA's records.
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