Form SSA-89 Authorization for the Social Security Administration (Ssa) to Release Social Security Number (Ssn) Verification

What Is the SSA-89 Form?

Form SSA-89, Authorization for the Social Security Administration to Release Social Security Number (SSN) Verification is a form used for procuring data from the Social Security Administration (SSA) to allow the third party to prove the connection between a person's name and a social security number. This verification is a mandatory requirement for mortgage lenders, credit check agencies, etc. It helps protect you against fraud and identity theft. For example, when it comes to mortgage, lenders want to know that the borrowers are indeed who they say they are. It is a crucial component in the employment screening process both pre- and post-hire.

Consent Based Social Security Number Verification (CBSV) Service is administered through the SSA and is usually used by companies that process credit checks, provide mortgage and banking services, satisfy licensing requirements, provide background checks, etc. Any social security number holder can request verification. It should be noted that the CBSV does not verify citizenship, identity, or employment eligibility.

The latest version of the form was released by the SSA in February 2018 with all previous editions obsolete. An SSA-89 fillable form is available for download and digital filing below.

Form SSA-89-SP, Autorización para que la Administración de Seguro Social Divulgue la Verificación de un Número de Seguro Social (SSN) is a related form in Spanish, used for the same purposes. This standardized consent form also allows the SSA to verify social security number information.

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Form SSA-89 (02-2018)
Page 1 of 2
Discontinue Previous Editions
Social Security Administration
OMB No.0960-0760
Authorization for the Social Security Administration (SSA)
To Release Social Security Number (SSN) Verification
Social Security Number:
Printed Name:
Date of Birth:
I want this information released because I am conducting the following business transaction:
Reason (s) for using CBSV: (Please select all that apply)
Mortgage Service
Banking Service
Background Check
License Requirement
Credit Check
Other
with the following company ("the Company"):
Company Name:
Company 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.
The name and address of the Company's Agent is:
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 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):
Contact information of individual signing authorization:
Address:
City/State/ZIP:
Phone Number:
Form SSA-89 (02-2018)
Page 1 of 2
Discontinue Previous Editions
Social Security Administration
OMB No.0960-0760
Authorization for the Social Security Administration (SSA)
To Release Social Security Number (SSN) Verification
Social Security Number:
Printed Name:
Date of Birth:
I want this information released because I am conducting the following business transaction:
Reason (s) for using CBSV: (Please select all that apply)
Mortgage Service
Banking Service
Background Check
License Requirement
Credit Check
Other
with the following company ("the Company"):
Company Name:
Company 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.
The name and address of the Company's Agent is:
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 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):
Contact information of individual signing authorization:
Address:
City/State/ZIP:
Phone Number:
Form SSA-89 (02-2018)
Page 2 of 2
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.
-----------------------------------------------------------TEAR OFF-------------------------------------------------------------------
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.

Download Form SSA-89 Authorization for the Social Security Administration (Ssa) to Release Social Security Number (Ssn) Verification

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What Is SSA-89 Form Used for?

Form SSA-89 - also known as the SSA Form 89 - efficiently verifies whether a name and a Social Security Number combination match the data in the SSA records. It is generally used for a background check or pre-employment screening, credit check, seeking employment, a mortgage loan, a license, and insurance. The CBSV provides real-time validation of an individual's personal data - a full name, a social security number, a date of birth, and a death indicator which helps mitigate identity theft and fraud.

Form SSA-89 Instructions

  1. Fill out the form completely and legibly;
  2. Place only one piece of information in one field;
  3. All the dates in the form must be in identical formats. The variations of the dates are not acceptable;
  4. Enter your full name, your date of birth, and social security number;
  5. Indicate the reason you want the information released. It is valid and efficient for all legitimate business verification purposes, including, for example, pre-employment background screening, banking services, personal loans;
  6. Select a reason for using CBSV - a mortgage service, a background check, a credit check, a banking service, a license requirement, etc.;
  7. State the company's name and current address;
  8. If applicable, write down the name and address of the company's agent;
  9. Certify you are the individual to whom the social security number was issued or the legal guardian or the parent of a minor or a legally incompetent adult;
  10. Affirm that the information contained in the form is correct and true. Be careful and provide all your information exactly how it appears in the SSA records. If this is not the case, the verification process may be unsuccessful or delayed. If the form is completed with false information, you could be found guilty of a misdemeanor and fined up to $5000;
  11. Indicate the consent's period of validity;
  12. Sign the form and write down the actual date. Once you sign the form, it is valid for 90 days unless you state otherwise. If the 90 days have passed and the company still has not verified your social security number information, you will have to sign another copy. Hence, it is very important to write down the actual date along with the signature;
  13. Fill out the «Relationship» field if you are a legal guardian or a parent;
  14. Provide the contact information - your current address and a phone number;
  15. You do not need to provide any additional materials or supporting documents for this consent form to be effective.

Form SSA-89 FAQ

Why Do I Need to Fill out the SSA-89?

In situations where you need to prove that the social security number is yours, you have a right to use this form. When you provide your social security number, you use a secure and unique method of identifying yourself. You prove that the social security number is actually assigned to you by using the SSN verification form. In many cases, mortgage lenders or banks require this document as a protection measure against identity theft. Normally, you will not have to be the one to initiate the process of completing the form. To the contrary, a third party is the one that usually requests you to sign it at the appropriate point in the business transaction process.

Why Is the SSA-89 Form Required for a Mortgage Loan?

Mortgage companies gather information in order to give you the loan. They usually ask for your income and expenses, employment history, loans, and bank accounts, what real estate you already own, whether you are involved in any lawsuits or filed for bankruptcy. Additionally, they are allowed to ask for your social security number. They have the responsibility to make sure the information you submitted is true to protect themselves and you from identity fraud.

Where to Send Form SSA-89?

The consent-based SSN verification form (CBSV) or the CBSV SSA-89 Form is different from other social security forms. When you download, print and complete a paper version of the form, you can simply mail it or take it to the third party that has requested it and that you have listed on the form. After that, the company or its official will enroll in the CBSV and, using the form, will obtain the actual verification of your social security number. Then you will be able to move forward with whatever business transaction you are undergoing.

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