Form Ssa 89 PDF Details

Navigating the complexities of financial, employment, and various verification processes often requires proving one's identity beyond a shadow of doubt. In the midst of these situations, the Form SSA-89 becomes a crucial document. This form, officially known as "Authorization for the Social Security Administration (SSA) To Release Social Security Number (SSN) Verification," serves a vital purpose. It empowers individuals to authorize the SSA to confirm their identity by verifying their name and Social Security number with specified entities for specific reasons. These reasons can range from applying for a mortgage, loan, or job to fulfilling licensing requirements or opening financial accounts. The form details include not only personal information such as the person's name, date of birth, and SSN but also the company seeking the verification and, if applicable, their agent’s details. As a protective measure, the form allows this verification for a one-time use within a 90-day period, ensuring a safeguard against unauthorized continuous access to an individual’s SSN verification. Additionally, it underscores the penalties associated with misrepresentation and the voluntary nature of providing the information, albeit with potential consequences for non-compliance. Furthermore, the form is placed within a broader context of privacy and paperwork reduction directives, showcasing a balance between personal privacy and the necessity of information sharing in certain contexts. Understanding the Form SSA-89 is not just about knowing what to fill out; it's about appreciating its role in protecting individuals' identities while facilitating necessary verifications in a structured, secure manner.

QuestionAnswer
Form NameForm Ssa 89
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesssa 89 form pdf, ssa89, form ssa 89 form, ssa 89 form

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Form SSA-89 (12-2020)

 

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Social Security Administration

OMB No.0960-0760

Authorization for the Social Security Administration (SSA)

To Release Social Security Number (SSN) Verification

Printed Name:

Reason for authorizing consent: (Please select one)

Date of Birth:

Social Security Number:

To apply for a mortgage

To apply for a loan

To meet a licensing requirement

To open a bank account

To open a retirement account

Other

To apply for a credit card

To apply for a job

 

 

 

 

 

 

With the following company ("the Company"):

 

 

 

 

 

 

 

Company Name:

 

 

 

Company Address:

The name and address of the Company's Agent (if applicable):

Agent's Name:

Agent's Address:

I authorize the Social Security Administration to verify my name and SSN to the Company and/or the Company's Agent, if applicable, for the purpose I identified. I am the individual to whom the Social Security number was issued or the parent or legal guardian of a minor, or the legal guardian of a legally incompetent adult. I declare and affirm under the penalty of perjury that the information contained herein is true and correct. I acknowledge that if I make any representation that I know is false to obtain information from Social Security records, I could be found guilty of a misdemeanor and fined up to $5,000.

This consent is valid only for one-time use. This consent is valid only for 90 days from the date signed, unless indicated otherwise by the individual named above. If you wish to change this timeframe, fill in the following:

This consent is valid for

 

days from the date signed.

(Please initial.)

 

 

 

 

 

 

Signature:

 

 

 

 

Date Signed:

 

 

 

 

 

 

Relationship (if not the individual to whom the SSN was issued):

Privacy Act Statement Collection and Use of Personal Information

Sections 205(a) and 1106 of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent us from releasing information to a designated company or company’s agent. We will use the information to verify your name and Social Security number (SSN). In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs. A list of routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0058, entitled Master Files of SSN Holders and SSN Applications. Additional information and a full listing of all our SORNs are available on our website at www.socialsecurity.gov/foia/bluebook.

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 control number. We estimate that it will take about 3 minutes to complete the form. You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send to this address only comments relating to our time estimate, not the completed form.

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NOTICE TO NUMBER HOLDER

The Company and/or its Agent have entered into an agreement with SSA that, among other things, includes restrictions on the further use and disclosure of SSA's verification of your SSN. To view a copy of the entire model agreement, visit http://www.ssa.gov/cbsv/docs/SampleUserAgreement.pdf.

How to Edit Form Ssa 89 Online for Free

Due to the goal of making it as easy to use as possible, we made this PDF editor. The whole process of preparing the social security authorization can be convenient for those who check out the following steps.

Step 1: Click the "Get Form Now" button to get going.

Step 2: The document editing page is presently available. It's possible to add information or edit existing details.

Provide the content requested by the application to prepare the document.

portion of gaps in form ssa 89 form

Provide the demanded information in the space This consent is valid only for, This consent is valid for days, Signature, Date Signed, Relationship if not the individual, Privacy Act Statement Collection, Sections a and of the Social, and This information collection meets.

step 2 to filling out form ssa 89 form

Highlight the most crucial details about the The Company andor its Agent have section.

Filling in form ssa 89 form stage 3

Step 3: Select the "Done" button. Now it's possible to transfer the PDF document to your gadget. As well as that, it is possible to send it by electronic mail.

Step 4: In avoiding probable forthcoming difficulties, you should have more than two or three duplicates of any form.

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