Form SSA-89 at a glance
What it is: This is the Authorization for the Social Security Administration (SSA) To Release Social Security Number (SSN) Verification.
Who signs: Enter your Signature and the Date Signed.
A filled-in Form SSA-89 example: a bank account holder authorizes SSN verification
How to fill out Form SSA-89, box by box
Printed Name, Date of Birth and Social Security Number
Enter the Printed Name, Date of Birth and Social Security Number.
Reason for authorizing consent: (Please select one)
Under Reason for authorizing consent, select one: To apply for a mortgage, To open a bank account, To apply for a credit card, To apply for a loan, To open a retirement account, To apply for a job, To meet a licensing requirement or Other.
With the following company ("the Company")
Name the company ("the Company") by entering the Company Name and the Company Address.
The name and address of the Company's Agent (if applicable)
Enter the name and address of the Company's Agent (if applicable): the Agent's Name and the Agent's Address.
This consent is valid for days from the date signed
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 in Printed Name. 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 and Relationship (if not the individual to whom the SSN was issued)
Enter your Signature, the Date Signed and the Relationship (if not the individual to whom the SSN was issued).
Common questions about Form SSA-89
What is the purpose of completing Form SSA-89?
This is the Authorization for the Social Security Administration (SSA) To Release Social Security Number (SSN) Verification. You authorize the Social Security Administration to verify your SSN (to match your name, SSN, and date of birth with information in SSA records and provide the results of the match) to the Company or Company's Agent, if applicable, for the purpose you identified. You also authorize SSA to disclose the basis for a no-match to the Company and/or Company Agent, when it is a Permitted Entity as defined by section 215 of the Economic Growth, Regulatory Relief, and Consumer Protection Act. You are the individual to whom the SSN was issued or the parent or legal guardian of a minor or legally incompetent adult. You declare and affirm under the penalty of perjury that the information contained herein is true and correct. If you make any representation that you know is false to obtain information from Social Security records, you could be found guilty of a misdemeanor and fined up to $5,000 (checked October 20, 2026).
Sources
[1] Form SSA-89 (05-2025), Authorization for the Social Security Administration (SSA) To Release Social Security Number (SSN) Verification, Social Security Administration (the Official source link on this page).
