EVS One-Time Registration

EVS Federal Privacy Act Statement Third-Party Submitters
The information on this page and your signature on the Federal privacy act
statement serve as a formal agreement between your company and SSA. The
agreement will govern the verification of employee SSNs for those employers
who have executed wage reporting contracts with you. Under this agreement, the
contracts between your organization and the employers must be available for
inspection in the event that SSA should need to audit your records. EVS
promotional material must also be available for review.
You can use a fee-based approach when offering EVS to your clients. However,
caution should be taken. SSA offers services, like EVS, free of charge. Some
companies in the private sector offer those same services for a fee and develop
misleading brochures and advertisements. To discourage the use of misleading
mailings about Social Security and Medicare, Congress enacted specific
prohibitions in Section 312 of the Social Security Independence and Program
Improvements Act of 1994 that broadened the existing deterrents. The
prohibitions are codified at Title 42 of the U.S. Code, Section 1320b-10. You
should ensure that you are aware of these legal provisions and conform to their
requirements.
In a snapshot, you should:
§ Be cautious not to suggest to your clients that this service is only available
through you;
§ Advise all customers that this service is available at no cost from SSA and
that this service is not a unique or exclusive arrangement between SSA and
your company; and
§ Be sure not to give any impression when describing your EVS service to
your clients that your company has an arrangement that allows direct
access to SSA databases, program software, etc.
To register, sign and date the privacy statement and send it along with your
registration form to: Social Security Administration, OCO, DES, EVS, 300 N.
Greene Street, 5-E-10 North Building, Baltimore, Maryland 21290-0300. Forms
may also be faxed to: (410) 966-3366 or (410) 966-9439

EVS Federal Privacy Act Statement Third-Party Submitters
_________________________
Company Name
_________________________
Street Address
_________________________
City, State, Zip Code

EIN: __ __- __ __ __ __ __ __ __

1 certifies that it is authorized, under valid contracts with
The
all outside employers of any individual for whom it will request Social Security
number (SSN) verification, to handle annual wage reporting responsibilities with
1 hereby
the Social Security Administration (SSA). The
acknowledges that it is authorized, under this agreement, to request SSN
verification from SSA only for the purpose of handling annual wage reporting
1 understands that
responsibilities for these employers. The
SSA agrees to verify SSNs solely to help ensure the accuracy of wage reporting.
1 also understands that information received from records
The
maintained by SSA must be handled in accordance with the Privacy Act of 1974
(5 U.S.C. 552a). Under the terms of this Act, anyone who knowingly and
willfully request or obtains from a Federal agency under false pretenses, any
record concerning an individual or uses it for a purpose other than that for which
it was requested, shall be subject to a criminal penalty (5 U.S.C. 552a(1)(3)).
Misuse of a SSN also is a violation of the Social Security Act (42 U.S.C. 408).
Further, EVS information does not imply that you or your client intentionally
provided incorrect information about the employee's name or SSN. It is not a
basis, in and of itself, for your client to take any adverse action against an
employee. EVS should only be used to verify workers currently employed or an
entire payroll database. Your client's policy concerning the use of EVS should be
applied consistently to all workers, e.g., if used for new hires, verify all new hires;
if used to verify a client's database, verify the entire database. Any client/
employer that uses the information SSA provides regarding name/SSN
verification as a pretext for taking adverse action against an employee may violate
state or federal law and be subject to legal consequences.
Signature _____________________________

Date_____________________

Name (Printed) __________________________

Title ____________________

1/

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