Creation of SSN Requests, Data Entry, Documentation Maintenance Etc.

The purpose of this User Agreement is to establish the conditions, terms, and safeguards under which the Social Security Administration (SSA or Agency) will provide the Requesting Party verification of Social Security Numbers (SSN).

Definitions

Agency - The Social Security Administration (SSA)

Assertion – The Requesting Party’s claims to the completeness and accuracy of all transactions

Attestation – Declaration by the CPA that the assertions of the Requesting Party are accurate

Authorized User – Employee of the Requesting Party who has been authorized by the Requesting Party to submit SSN verification requests and has successfully registered to use the CBSV system.

BSO - Business Services Online

Client – SSN holder who authorizes the Requesting Party to verify his/her SSN through SSA by completing the Consent Form. Under SSA disclosure regulations, the parent or legal guardian of a minor or legal guardian of a legally incompetent adult may also authorize disclosure for the subject of the record if he/she is acting on the individual’s behalf and provides proof of the relationship.

Consent Form – Form SSA-89 (Authorization for SSA to Release SSN Verification – Attachment B).

Examination Engagement – The annual compliance review performed by the SSA-chosen CPA firm.

OCO – SSA’s Office of Central Operations.

OF – SSA’s Office of Finance.

Principal – Business organization or institution that is the original requesting source for the SSN verification and enters into a contractual relationship with the Requesting Party to secure SSN verifications from SSA. The Principal may or may not be the Requesting Party but is the end-user entity to which the SSN verification will ultimately be disclosed.

Requesting Party – Party signing this User Agreement with SSA, including any and all of its employees, officers, directors, agents, servants, subsidiaries, personal and legal representatives, affiliates, successors, assigns, and contractors.

Responsible Company Official – The officer or employee of the Requesting Party with authority to make legally binding commitments on behalf of the Requesting Party.

SSA – The Social Security Administration

SSN – Social Security Number

Legal Authority

Legal authority for providing SSN verifications to the Requesting Party with written consent of the SSN holder is found in the Freedom of Information Act, the Privacy Act at 5 U.S.C. § 552a(b), section 1106 of the Social Security Act, codified at 42 U.S.C. § 1306, and SSA regulation at 20 C.F.R. § 401.100.

SSN Verification and Use

SSA will verify SSNs solely for the purposes specified on the individual Consent Forms (Form SSA-89, Authorization for SSA to Release SSN Verification – Attachment B) associated with the verification requests. The Requesting Party must use the verified SSN only for the purpose(s) specified by the Client. Exceeding the scope of the consent as specified in the signed Consent Form violates state or Federal law and subjects the Requesting Party to civil and criminal liability. SSA recognizes that the Requesting Party may seek verification of the Client’s SSN on behalf of a Principal pursuant to the terms of the Client’s Consent Form. In this case, the Requesting Party shall ensure that the Principal agrees in writing to use the verification only for the purpose stated in the Consent Form, and make no further use or re-disclosure of the verified SSN. This relationship shall be subjected to the contractual obligations as specified in this document.

The information obtained from records maintained by SSA is protected by Federal statutes and regulations, including 5 U.S.C. § 552a(i)(3) of the Privacy Act. Under this section, any person who knowingly and willfully requests or obtains any record concerning an individual from an agency under false pretenses will be guilty of a misdemeanor and fined not more than $5,000.

SSA’s verification of an SSN does not provide proof or confirmation of identity. CBSV is designed to provide you with only a “yes” or “no” verification of whether the SSN verified with SSA’s records. If our records show that the SSN holder is deceased, CBSV returns a death indicator. CBSV verifications do not verify an individual's identity. CBSV does not verify employment eligibility, nor does it interface with the Department of Homeland Security’s (DHS) verification system, and it will not satisfy DHS’s I-9 requirements.

Responsibilities

Requesting Party Responsibilities

Requesting Party must designate a Responsible Company Official to sign the Attestation Statement (Attachment D) indicating understanding of the Privacy Act restrictions relating to the use of this service on behalf of the Requesting Party.

The signed and dated Attestation Statement must be submitted to SSA with the signed User Agreement.

If the Responsible Company Official signing the original Attestation Statement leaves the company or no longer has authority to make legally binding commitments on behalf of the company, Requesting Party must designate a new Responsible Company Official to submit a new signed Attestation Statement within 30 days.

Responsible Company Official must complete the Attestation Statement annually to be aware of responsibilities to establish effective internal controls over compliance with CBSV requirements. (See attachment D)
If a Requesting Party wishes the Agency to recognize the Requesting Party’s successor in interest to this Agreement or the Requesting Party’s name change, the Requesting Party must submit written notification to the CBSV Project Manager within 30 days of the change. Any submission should be accompanied by supporting documentation. Because this Agreement is not assignable, any successor in interest to this Agreement must sign a new User Agreement with the Agency.
Requesting Party will provide SSA with an electronic file through the CBSV website on Business Services Online (BSO) either (1) in batch mode format for response in two to three business days, or (2) as a single request for real-time response. Alternately, the Requesting Party may submit their request through a web service platform that conforms to SSA’s data configuration for a real-time response. All requests must specify the name, date of birth, and SSN of each Client whose SSN the Requesting Party seeks to verify.

If the Requesting Party elects to have its employees access CBSV by using SSA BSO either (1) in batch mode format, or (2) as a single request for real-time response option, the Requesting Party must complete the Form SSA-88 (Attachment A) with requested information for each Authorized User. The Requesting Party must use one Form SSA-88 to provide information for multiple Authorized Users. The Requesting Party must ensure that the Form SSA-88 provides the total number of the Requesting Party’s Authorized Users.
Requesting Party will notify SSA if there is any change to employment status (including, but not limited to, long-term absence, termination of employment, or change of duties related to CBSV) for any Authorized User or if Requesting Party revokes any Authorized User’s authorization to use CBSV.
SSA may change its method of receiving verification requests and providing verification results to the Requesting Party at any time. If SSA decides to change its method of receiving SSN verification requests or providing verification results, the Responsible Party will bear its own costs incurred to accommodate such changes.
Requesting Party will be audited at least annually by a Certified Public Accountant (CPA) designated by SSA. The cost of the Examination Engagement is factored into the transaction fee. The CPA’s report will provide an opinion on the requesting party’s assertion that it complied with the CBSV User Agreement requirements. (See Attachment E.)
Requesting Party must pay the one-time enrollment fee and full, advance payment of estimated transaction fees for the current fiscal year prior to making any request for verification under this User Agreement. Requesting Party will pay in full any remaining balance for verifications from previous fiscal year obligations before it uses CBSV for the following fiscal year.
Requesting Party will ensure that its Responsible Company Official carry out the following actions and responsibilities:

At the completion of the registration process, SSA will issue a unique access code to the Responsible Company Official. The Responsible Company Official will provide the access code to each Authorized User only after authenticating that Authorized User’s relationship to the Requesting Party and as authorization for that Authorized User to submit verification requests to CBSV.
Responsible Company Official must provide his and other Authorized Users’ information on Form SSA-88 if the Requesting Party elects to use its web service platform client application to access CBSV. Responsible Company Official will be the representative Authorized User for the Requesting Party when using the web service platform client application.
Responsible Company Official, jointly and on behalf of the Requesting Party will be responsible for all access requests made through the Requesting Party’s web service platform client application and for complying with the requirement to maintain an audit trail to track all CBSV activities of each Authorized User.

Requesting Party will ensure that any Principal to whom Requesting Party discloses SSA-verified information acknowledges and agrees to comply with all of the requirements, as applicable, under this User Agreement via a contractual relationship the Requesting Party establishes with the Principal as outlined in Attachment E.
The Requesting Party will inform all authorized personnel with access to confidential information of the confidential nature of the information and the administrative, technical and physical safeguards required to protect the information from improper disclosure. All confidential information must at all times be stored in an area that is physically safe from unauthorized access.

Requesting Party acknowledges the following

Section 1140 of the Social Security Act authorizes SSA to impose civil monetary penalties on any person who uses the words “Social Security” or other program-related words, acronyms, emblems and symbols in connection with an advertisement, solicitation or other communication, “in a manner which such person knows or should know would convey, or in a manner which reasonably could be interpreted or construed as conveying, the false impression that such item is approved, endorsed, or authorized by the Social Security Administration . . . .” 42 U.S.C. § 1320b-10(a).
Requesting Party, or any of its Principals, is specifically prohibited from using the words “Social Security” or other CBSV program-related words, acronyms, emblems and symbols in connection with an advertisement for “identity verification.”
Requesting Party, or any of its Principals, is specifically prohibited from advertising that SSN verification provides or serves as identity verification.
SSA has the right of access to all books and records of the Requesting Party, or any of its Principals, associated with the CBSV program at any time.

SSA Responsibilities

SSA will compare the information provided in the Requesting Party’s verification request with the information in SSA’s Master File of SSN Holders and SSN Applications System of Records and provide verification results in appropriate format and method based on the submission format and method.
If the Requesting Party submits batch files through the BSO website, SSA will provide submission confirmation by a posting on the CBSV portion of the BSO website. The Requesting Party will also be able to download the verification results file from the BSO website. Results for requests submitted via batch mode upload will generally be available within three business days. However, SSA cannot guarantee a specified time frame, as the Agency’s mission-related work will have priority over any verification requests. SSA’s posting of verification results may be delayed for Agency mission-related work or for system maintenance.
If the Requesting Party submits a single request using the web service, SSA will provide a real-time responses, barring any delays for system maintenance.
SSA will review CBSV submissions and results, conduct audits, generate reports, and conduct site visits as needed to ensure proper use to deter fraud and misuse. SSA, in its sole discretion, will determine the need for audits, reports, or site visits upon its review of the Requesting Party’s submissions, results, or CPA reports
SSA will send out notices or reminders to the Requesting Party requesting payment in an annual or quarterly amount.

Consent

A standardized Consent Form, Form SSA-89 (Authorization for SSA to Release SSN Verification), is included as Attachment B to this User Agreement. The Form SSA-89 consent form is an OMB approved form. This form must not be altered.

SSA will provide SSN verification information only about individuals from whom the Requesting Party has obtained a signed Consent Form. The Requesting Party must obtain a signed Consent Form from each person for whom SSN verification is requested. If the request is for a minor child (under age 18), a parent or a legal guardian must sign the Form SSA-89. If the request is for a legally incompetent adult, a legal guardian must sign theForm SSA-89. If the parent or legal guardian signs the Form SSA-89, the Requesting Party must retain proof of the relationship, e.g., a copy of the birth certificate or court documentation proving the relationship.

The Form SSA-89 must be completed and signed, and must include the date of birth of the SSN holder. The authorizing signature must be original and cannot be a digital or electronic signature. Neither the Requesting Party nor any Principal may make alterations to the Consent Form, unless it is made by the SSN holder to change the period during which the consent will be valid. The SSN holder must annotate and initial this change in the space provided on the Consent Form. The Requesting Party cannot request the SSN verification from SSA before receiving physical possession of a signed Consent Form from its Client. SSA must receive the request for SSN verification within the time period specified on the Consent Form, either 90 days from the date the Client signs the Consent Form, or by an alternate date established on the Consent Form.

The Requesting Party must retain the signed Form SSA-89s for a period of seven (7) years from the date of the verification request, either electronically or on paper. The Requesting Party must protect the confidentiality of completed Form SSA-89s and the information therein, as well as the associated record of SSN verification. The Requesting Party must also protect the Form SSA-89s from loss or destruction by taking the measures below. (See Section V.B for procedures on reporting Loss of Personally Identifiable Information (PII))

Requesting Party Retains Consent Forms in Paper Format

If the Requesting Party chooses to retain the Consent Forms in paper format, the Requesting Party must store the Consent Forms in a locked, fireproof storage receptacle. The Requesting Party shall restrict access to all confidential information to the minimum number of employees and officials who need it to perform the process associated with this User Agreement. The stored data must not be reused.

Requesting Party Retains Consent Forms Electronically

If the Requesting Party chooses to retain the Consent Forms electronically or store them on removable electronic media (such as CDs), the Requesting Party must: (1) password protect any electronic files used for storage; (2) restrict access to the files to Authorized Users; and (3) put in place and follow adequate disaster recovery procedures.

When using either of the electronic storage means, the Requesting Party must destroy the original paper Consent Forms.

SSA may make onsite inspections of the requester’s site, including a systems review, to ensure that the Requesting Party has taken the above required precautions to protect the Consent Forms and the information contained therein and to assess overall system security.

Each request submitted to SSA must contain a data field indicating that the Requesting Party has received a valid signed and dated Consent Form for that request in accordance with all requirements under this User Agreement. In addition, each Authorized User, as part of the registration as an Authorized User, must certify to SSA that: (i) he or she will submit requests to SSA only when he or she has information, knowledge, or a reasonable belief that the requests are supported by the requisite Consent Forms, and (ii) any request submitted to SSA without the requisite consent form is subject to legal penalties and could lead to termination of this User Agreement.

Technical Specifications and Systems Security and Related Business Process Requirements

Technical Specifications and Systems Security

The Requesting Party will not have direct access to SSA’s databases. The verification requests must be encrypted using either the Advanced Encryption Standard (AES) or triple DES (DES3) encryption methods to secure the data in transport to SSA. SSA will use the same method of encryption when returning data to the Requesting Party. To accomplish the transmission of data, the parties will use TLS protocol (TLS 1.0). .

The Requesting Party must obtain, at its own expense, the hardware, software, or other equipment that may be necessary to establish connection to CBSV either through the BSO website or the web service. The Requesting Party must obtain, at its own expense, Internet service in order to access the CBSV portion of the BSO website. The Requesting Party must provide SSA with a valid e-mail address for communications via e-mail.

The Requesting Party may use more than one method of CBSV services (online, web service and batch) at the same time. If the Requesting Party chooses to use both online and web service, it must assign two different Authorized Users, due to the unique registration needs of CBSV Web Service. The Requesting Party is only responsible for the one-time enrollment fee ($5000) and one combined annual advance payment for estimated transactions, regardless of the number of methods of services it uses.

The Requesting Party must bear all costs it incurs for site preparation, connection, operating costs, and any other miscellaneous costs to participate in CBSV. SSA reserves the right to conduct on-site visits to review the Requesting Party’s documentation and in-house procedures for protection of and security arrangements for confidential information and adherence to terms of this User Agreement.

SSA will provide the Requesting Party with a copy of SSA’s User Guide, which SSA may amend at its discretion. The detailed requirements and procedures for submitting files, checking status, and retrieving results through CBSV are set forth in the User Guide.

If the Requesting Party accesses CBSV through the web service platform client application, the Requesting Party must maintain an automated audit trail record identifying either the individual Authorized User or the system process that initiated a request for information from SSA. Every request for information must be traceable to the individual Authorized User or the system process that initiated the transaction. At a minimum, individual audit trail records must contain the data needed to associate each request to its initiator and the relevant business purpose (e.g., the outside entity’s client record for which SSA data was requested), and each request must be time and date stamped. Each request must be stored in the audit file as a separate record, not overlaid by subsequent requests.

If the Requesting Party retains in its system any verification results from SSA, or if certain data elements within the Requesting Party’s system indicate that the information has been verified by SSA, the Requesting Party must ensure that its system also captures an audit trail record, with the same requirements as for the web service platform client application, of any user who views the SSA-verified information stored within the Requesting Party’s system.

The Requesting Party shall process all confidential information under the immediate supervision and control of authorized personnel in a manner that will protect the confidentiality of the records; prevent the unauthorized use of confidential information and prevent access to the records by unauthorized persons.

B. Protecting and Reporting the Loss of Personally Identifiable Information (PII)

PII is any information about an individual maintained by an entity, including (1) any information that can be used to distinguish or trace an individual‘s identity, such as name, SSN, date and place of birth, mother‘s maiden name, or biometric records; and (2) any other information that is linked or linkable to an individual, such as medical, educational, financial, and employment information.”

Requesting Party Responsibility in Safeguarding PII

The Requesting Party shall establish, maintain, and follow its own policy and procedures to protect PII, including policies and procedures for reporting lost or compromised, or potentially lost or compromised, PII. The Requesting Party shall inform its Authorized Users which handle PII of their individual responsibility to safeguard such information. In addition, the Requesting Party shall, within reason, take appropriate and necessary action to: (1) educate Authorized Users on the proper procedures designed to protect PII; and (2) enforce their compliance with the policy and procedures prescribed.

All Authorized Users shall properly safeguard PII from loss, theft, or inadvertent disclosure. Each Authorized User is responsible for safeguarding this information at all times, regardless of whether or not the user is at his or her regular duty station.

Reporting Lost, Compromised or Potentially Compromised PII

When the Requesting Party or its Authorized User becomes aware or suspects that PII has been lost, compromised, or potentially compromised the Requesting Party, in accordance with its incident reporting process, shall provide immediate notification of the incident to the primary SSA contact. If the primary SSA contact is not readily available, the Requesting Party shall immediately notify one of two SSA alternates, if names of alternates have been provided. (See Section XVI for the phone numbers of the designated primary and alternate SSA contacts.) The Requesting Party shall act to ensure that each Authorized User has been given information as to who the primary and alternate SSA contacts are and how to contact them.

(b) The Requesting Party shall provide the primary SSA contact or the alternate, as applicable, updates on the status of the reported PII loss or compromise as they become available but shall not delay the initial report.

(c) The Requesting Party shall provide complete and accurate information about the details of the possible PII loss to assist the SSA contact/alternate, including the following information:

Contact information;
A description of the loss, compromise, or potential compromise (i.e., nature of loss/compromise/potential compromise, scope, number of files or records, type of equipment or media, etc.) including the approximate time and location of the loss;
A description of safeguards used, where applicable (e.g., locked briefcase, redacted personal information, password protection, encryption, etc.);
Name of SSA employee contacted;
Whether the Requesting Party or the Authorized User has contacted or been contacted by any external organizations (i.e., other agencies, law enforcement, press, etc.);
Whether the Requesting Party or the Authorized User has filed any other reports (i.e., Federal Protective Service, local police, and SSA reports); and
Any other pertinent information

Referral of Individuals to SSA

If SSA returns a “no-match” result (see SSA’s User Guide) to the Requesting Party, the Requesting Party must take the following actions before making any referrals to SSA Field Offices for action:

The Requesting Party will determine whether the data submitted to SSA matches the data contained in the Requesting Party’s records. If it does not match the Requesting Party will re-submit the corrected data to SSA for verification. The Requesting Party will bear the cost for the resubmission.

If the data in the Requesting Party’s records matches the data submitted to SSA, the Requesting Party will contact the Client to verify the original data provided. If the Client corrects the original data by completing and signing a new Consent Form with the corrected information, the Requesting Party should submit the corrected data to SSA for verification. The Requesting Party will bear the cost for the resubmission.
If the Requesting Party cannot resolve the data discrepancy, the Requesting Party will refer the individual to a SSA Field Office to determine the nature of the problem.

Costs of Service

The Requesting Party must provide SSA with advance payment for the full annual cost of all services rendered under this User Agreement.

Upon signing this Agreement, the Requesting Party must deposit with SSA, either by company check or company credit card, a one–time, nonrefundable registration fee of five thousand dollars ($5,000), which will be applied to SSA’s total CBSV operating costs to reduce the actual transaction fees charged to all users. This fee allows the Requesting Party to access all three CBSV service methods.

Payment for transaction fees will be submitted with a completed and signed Form SSA-1235 (Agreement Covering Reimbursable Services—Attachment C). Prior to the start of each new fiscal year, the Requesting Party must submit a new, signed Form SSA-1235, accompanied by the full payment of fees for estimated requests for that fiscal year. In cases when estimated costs have changed, the requesting party will remain in active status as long as their account balance is positive. SSA will credit the account of the Requesting Party and “draw down” from the advanced payment as services are rendered. Services will be provided only if sufficient amount of advance payment remains in the Requesting Party’s account to cover the requested services. No interest shall accrue to the advance payment. In cases when estimated costs have changed, the Requesting Party will remain in active status as long as their account balance is positive. If any file submitted does not conform to the requirements of the User Agreement or the User Guide, the Requesting Party must still pay for the full cost of processing that file.

Periodically, but no less frequently than annually, SSA will recalculate its costs related to providing the CBSV services and will adjust the transaction fees accordingly. If the recalculation of costs results in increased fees, the Requesting Party may need to sign an amended Form SSA-1235 and submit additional advance payments.

Duration of Agreement, Suspension of Services, and Annual Renewal

Duration and Termination of Agreement

This User Agreement is effective upon signature of both parties, including a signed Form SSA-1235 and payment in full of all fees due and owing under such Form SSA-1235, and shall remain in effect until terminated or cancelled as follows:

The Requesting Party may terminate this User Agreement by giving 30-days advance written notice to SSA of its decision to cancel the User Agreement. If the Requesting Party wishes to cancel their participation in CBSV, it must send a written notice to the SSA Contact stating its intent to cancel. This User Agreement will be terminated effective 30 days after SSA receives such notice or at a later date specified in the notice;

SSA and the Requesting Party may mutually agree in writing to cancel the User Agreement, in which case the termination will be effective on the date specified in such termination agreement;

SSA may terminate this User Agreement upon determination, in its sole discretion, that the Requesting Party has failed to comply with its responsibilities under this User Agreement, including without limitation its obligation to make advance payment, requirement to use the Consent Form without modification and in accordance with this User Agreement, and its responsibilities under section X Compliance Reviews and has not corrected its non-compliance within 30 days of SSA’s notice of such non-compliance;

The User Agreement or the CBSV service is prohibited by applicable law or regulation, in which case this User Agreement will be null and void as of the effective date specified in such law or regulation; or

SSA may terminate this User Agreement as a result of its decision, in its sole discretion, to cancel the CBSV services. In case of such cancellation of CBSV services, SSA will provide all participants in the CBSV program with written notice of SSA’s decision. The termination of this User Agreement pursuant to cancellation of the CBSV services will be effective five days from the date of such notice to the Requesting Party.

If the company is dissolved, the User Agreement is no longer valid. The new entity must sign a new User Agreement. The parent company is not accountable for the subsidiary’s actions.

The Requesting Party specifically waives any right to judicial review of SSA’s decision to cancel the provision of CBSV services or terminate this User Agreement.

After the close of the fiscal year in which this User Agreement is terminated, SSA will refund to the Requesting Party any remaining advance payment of transaction fees. If the User Agreement is terminated early in the fiscal year, SSA reserves the right to refund the balance of advance payment prior to the close of the fiscal year. Notwithstanding the foregoing, the one-time enrollment fee is not refundable upon termination of this User Agreement for any reason.

Suspension of Services

Suspension is a temporary action imposed by SSA on a Requesting Party for a designated period until certain requirements are met or rectified. Suspension is immediate upon notice by SSA to the Requesting Party and remains in effect until lifted by SSA.

Noncompliance with this User Agreement, including assertions set forth in Attachment E – CBSV Attestation Requirements & Requesting Party Compliance Assertions of this User Agreement, is subject to suspension of CBSV services at the sole discretion of SSA.

Suspension will be effective immediately upon SSA’s notice, specifying the reason for the suspension, sent via e-mail to the Requesting Party’s Responsible Company Official, and will remain in effect until SSA’s further determination.

If the Requesting Party disputes SSA’s decision to suspend its access, the Requesting Party may elect to write a letter to SSA specifying its reasons for contesting the suspension. Such letters may be sent via e-mail and must be received by SSA within five calendar days from the date that SSA transmitted the notice of suspension to the Responsible Company Official.

After reviewing the Requesting Party’s letter, SSA may make the final determination to: 1) lift the suspension; 2) continue the suspension; or 3) terminate this User Agreement. SSA will provide the Requesting Party with written notice of its final decision.

The Requesting Party specifically waives any right to judicial review of SSA’s decision to suspend or terminate this User Agreement.

The Requesting Party's use of the CBSV system may be suspended for any of the following reasons:

Non-Payment,
Violation of User Agreement Terms, or
Temporary Fix for an Active Record

Noncompliance can fall into one of three tiers:

Type I noncompliance consists of multiple failures that significantly place PII at risk or have resulted in unauthorized disclosure of PII and are systemic in nature.
Type II noncompliance consists of a failure that could result in an unauthorized verification being submitted to SSA or a failure related to a specific Consent Form or verification that places PII at risk. A Type II noncompliance may also be a failure which might prevent the completion of the examination attestation engagement by a CPA.
Type III noncompliance consists of failures that are only minor in nature. Type III noncompliance would not result in either unauthorized disclosure of PII or unauthorized verification being submitted to SSA.

The following are the three types of noncompliance and their resulting penalties.

Tier	Noncompliance	Penalty
Type I	Multiple failures to comply with CBSV user agreement requirements determined by SSA to be detrimental to protection PII Multiple Type II noncompliance Fraudulent use of CBSV access privileges Other issues considered by SSA to place a significant quantity PII at risk.	Suspension of CBSV user privileges for 90 days
Type II	Verification not authorized by SSN holder including missing, unsigned, or fraudulent Form SSA-89, Form SSA-89 accepted without date of authorization, Multiple verifications authorized by one Form SSA-89, Form SSA-89 submitted beyond 90 days from the date authorization was signed, outside alternate timeframe or before date of authorization. Acceptance of electronic/digital signature on Form SSA-89, Retention requirements not followed, Purpose stated on Form SSA-89 not specific or allowable, Significant alteration of Form SSA-89, SSA-88 not current, CBSV system access codes are not safeguarded, Agreements between Requesting Party and Principals do not contain required elements, Form SSA-89s are not stored securely, Audit trail requirements are not followed, or Other issues determined by SSA to be compliance failures.	Suspension of CBSV user privileges for 60 days
Type III	Illegible Form SSA-89 (fields not specified above), Requesting Party phone number not included on Form SSA-89, Principal address not included on Form SSA-89, Requesting Party information incorrect, Minor alteration of Form SSA-89 wording Late submission of examination attestation report Other issues determined by SSA to be minor noncompliance.	Suspension of CBSV user privileges for 30 days

Annual Renewal

This User Agreement does not authorize SSA to incur obligations through the performance of the services described herein. Performance of such services is authorized only by execution of Form SSA-1235 (Agreement Covering Reimbursable Services – Attachment C). Moreover, SSA may incur obligations by performing services under this User Agreement only on a fiscal year basis. Accordingly, attached to, and made a part of, this User Agreement, is a Form SSA-1235 that provides the authorization for SSA to perform services under this User Agreement in fiscal year [XXXX].

Because SSA’s performance under this User Agreement could span multiple fiscal years, SSA and the Requesting Party will prepare a new Form SSA-1235 at the beginning of each succeeding fiscal year during which SSA will incur obligations through the performance of the services described in this User Agreement. The parties will sign the Form SSA-1235 for the applicable fiscal year on or before the beginning of the Federal fiscal year (October 1^st). SSA’s ability to perform work for fiscal years beyond the current fiscal year is subject to the availability of funds.

If the Requesting Party has excess funding at the end of the fiscal year, SSA will refund the excess amount in October of the new fiscal year. The refund of remaining funds from a previous fiscal year is a separate transaction; it does not automatically carryover to the following fiscal year.

Under the Debt Collection Improvement Act of 1996 and the Federal Acquisition Regulation (FAR), the Requesting Party must register in the Central Contractor Registration (CCR) and enroll in direct deposit to receive payments from the Federal government.

The Requesting Party can register in CCR and request a Data Universal Number System (DUNS) number by visiting www.bpn.gov/ccr/default.aspx on the Internet. SSA will make payments based on the Requesting Party’s banking information as registered in CCR. When completing the Form SSA-1235, the Requesting Party must include its DUNS number.

Users must complete an annual Attestation Statement in order to remain aware of responsibilities to establish effective internal controls over compliance with CBSV requirements.

Compliance Reviews

Mandatory Compliance Review by Independent CPA

The Requesting Party and any of its Principals are subject to a mandatory compliance review (Examination Engagement). SSA will determine the frequency of the Requesting Party’s compliance review, which must be no less frequently than annually, with additional reviews as SSA determines to be appropriate. The actual date of the compliance reviews will be determined by SSA in consultation with the reviewing CPA.

Initiating the Compliance Review

A SSA appointed CPA firm will perform an annual audit of the Requesting Party’s management assertion that all authorized transactions are complete and accurate. The CPA firm will perform the Examination Engagement in accordance with the standards established by the American Institute of Certified Public Accountants and contained in the Generally Accepted Government Audit Standards (GAGAS).
SSA will email a notice to the Requesting Party identifying the name of the retained CPA firm and its designated contact.
SSA will provide to the CPA a statistically-valid random sample of the Requesting Party’s verifications identified by name, SSN and date of birth along with the verification results provided to the Requesting Party. SSA will use the U.S. Government Accountability Office (GAO) President’s Council on Integrity and Efficiency’s (PCIE) Financial Audit Manual (FAM), Section 460, Compliance Tests in determining the sample size.

Requesting Party’s Cooperation with the Compliance Review

The Requesting Party will:

Provide to the reviewing CPA a copy of this signed User Agreement and all applicable attachments in their entirety; and
Inform all of its Principals of the requirement to produce supporting documentation upon CPA’s request for purposes of compliance reviews.

In performance of the Examination Engagement under this User Agreement, the CPA must use the review assertions specified in Attachment E, CBSV Attestation Requirements & Repesting Party Compliance Assertions (Audit).

In addition the CPA must:

Follows standards established by the AICPA and contained in GAGAS.
Provides a report containing the results of the Examination Engagement to the designated SSA contact within 30 days after completing the Examination Engagement.
Provides the Requesting Party with a copy of the report 30 days after the report is provided to SSA, unless SSA informs the CPA otherwise.

If the results of the CPA’s review indicate that the Requesting Party has not complied with any term or condition of this User Agreement, SSA may:

Perform its own onsite inspection, audit, compliance review,
Refer the report to its Office of the Inspector General for appropriate action, including referral to the Department of Justice for criminal prosecution,
Suspend CBSV services,
Terminate this User Agreement; and/or,
Take any other action SSA deems appropriate.

See Attachment E for a list of the compliance and the non-compliance assertions.

Amendments to User Agreement

Mutual Amendments

Parties may amend this User Agreement at any time by mutual agreement in writing.

Unilateral Amendments

SSA reserves the unilateral right to amend this User Agreement at any time to implement the following:

Minor administrative changes, such as changes to SSA contact information; or
Procedural changes, such as method of transmitting requests and results and limits on number of verification requests.

SSA will notify the Requesting Party of any unilateral amendments under this section. If the Requesting Party does not wish to be bound by any such unilateral amendment, the Requesting Party may terminate this User Agreement with 30 days’ notice.

Indemnification

Notwithstanding any other provision of this User Agreement, the Requesting Party will indemnify and hold SSA harmless from all claims, actions, causes of action, suits, debts, dues, controversies, restitutions, damages, losses, costs, fees, judgments, and any other liabilities caused by, arising out of, associated with, or resulting directly or indirectly from, any acts or omissions of the Requesting Party, including but not limited to the disclosure or use of information by the Requesting Party or its Principal, or any errors in information provided to the Requesting Party under this User Agreement. SSA is not responsible for any financial or other loss incurred by the Requesting Party, whether directly or indirectly, through the use of any data provided pursuant to this User Agreement. SSA is not responsible for reimbursing the Requesting Party for any costs the Requesting Party incurs pursuant to this User Agreement.

Disclaimers

SSA is not liable for any damages or loss resulting from errors in information provided to the Requesting Party under this User Agreement. Furthermore, SSA is not liable for damages or loss resulting from the destruction of any materials or data provided by the Requesting Party. All information furnished to the Requesting Party will be subject to the limitations and qualifications, if any, transmitted with such information. If, because of any such error, loss, or destruction attributable to SSA, SSA must re-perform the services under this User Agreement, the additional cost thereof will be treated as a part of the full costs incurred in compiling and providing the information and will be paid by the Requesting Party.

SSA’s performance of services under this User Agreement is authorized only to the extent that they are consistent with performance of the official duties and obligations of SSA. If for any reason SSA delays or fails to provide the services, or discontinues all or any part of the services, SSA is not liable for any damages or loss resulting from such delay, failure, or discontinuance.

Nothing in this User Agreement is intended to make any person or entity who is not a signatory to this User Agreement a third-party beneficiary of any right created by this User Agreement or by operation of law.

Integration

This User Agreement and the accompanying Form SSA-1235 constitute the entire agreement of the parties with respect to its subject matter. There have been no representations, warranties or promises made outside of this User Agreement. This User Agreement shall take precedence over any other documents that may be in conflict with it.

Resolution Mechanism

In the event of a disagreement between the parties to this User Agreement, the parties will meet and confer to attempt to negotiate a resolution. If the parties cannot agree on a resolution, the parties will submit the dispute in writing to the Deputy Commissioner, Office of Budget, Finance and Management, of SSA, who will render a final determination binding on both parties.

Persons to Contact

SSA Contacts

CBSV Project and Technical Support Team

Electronic Mail: [email protected] or [email protected]

Call: 888-772-2970

User Agreement Liaison

CBSV Agreement Coordinator

P. O. Box 33006

Baltimore, MD 21290-3006

Telephone: 866-395-8801

Electronic Mail: [email protected]

Billing and Payment Issues

Office of Finance

Attention: CBSV

2-M-2 East Low Rise

6401 Security Blvd.

Baltimore, MD 21235-6401

410-597-1673

Electronic Mail: [email protected]

NOTE: Advance payment (by company check or company credit card) is required.

Company checks must be mailed to the following address with a copy of the signed SSA-1235 (Agreement Covering Reimbursable Services):

Social Security Administration

ATTN: CBSV

6401 Security Blvd.

P.O. Box 17042

Baltimore, Maryland 21235

Reporting Lost, Compromised or Potentially Compromised PII

Office of Public Service and Operations Support

Project Manager: 410-966-8502

Alternate Contact: 410-966-4963

Requesting Party Contacts

REMINDER: Changes should be reported to SSA within 30 days.

Company Name: __________________________________________

Responsible Company Official: __________________________________________

Title: __________________________________________

Address: __________________________________________

__________________________________________

Telephone: __________________________________________

Fax: __________________________________________

Electronic Mail: __________________________________________

Authorizing Signatures and Dates

The signatories below warrant and represent that they have the competent authority on behalf of their respective entities to enter into the obligations set forth in this User Agreement.

For Social Security Administration:

_________________________________ Date __________

(Signature)

Van Nguyen

Associate Commissioner, Office of Central Operations

For Requesting Party:

_________________________________ Date __________

(Signature)

Name: ________________________________

Title: _______________________________________

Company Name: ______________________________

Attachment A – Form SSA-88 Form Approved

OMB #0960-0760

Pre-Approval Form For

Consent Based Social Security Number Verification (CBSV)

COMPANY REGISTRATION

Name of the Company

Company Address (P.O. Box alone is not acceptable)

Address Line 1 __________________________________________________

Address Line 2 __________________________________________________

City, State, Zip __________________________________________________

EIN (Employer Identification Number)

(Provide primary EIN if your company uses more than one.)

Designated email mailbox for receipt of technical bulletins from SSA: __________@________. Please note, the SSA will only send technical bulletins to one email address per company. You may provide this information later if you do not have one now.

EMPLOYEE(S) AUTHORIZED TO USE CBSV

List the names of all employees unless your company will access CBSV solely through a web service platform. Note: If your company will access CBSV solely through a web service platform, please provide corresponding information of the Responsible Company Official as the employee authorized to use CBSV.

Name of Employee(s) Authorized to Use CBSV:

Telephone Number of Employee(s) Authorized to Use CBSV:

(include area code)

Email Address of Employee(s) Authorized to Use CBSV:

AUTHORIZED SIGNATURE OF RESPONSIBLE COMPANY OFFICIAL

7. ______________________________________

Name of Responsible Company Official (print or type)

______________________________________

Signature of Responsible Company Official

______________________________________ _________________

Title Date

______________________________________

Telephone Number (include area code)

______________________________________

Email Address

See SSA’s CBSV User Guide for information regarding the extent and nature of employee’s authority to use CBSV.

Notify us if your authorized employee leaves your company or if you choose to revoke any or all of your employee's authorization to use SSA's Business Services Online (BSO).

Form SSA-88

Privacy Act Notice

The Social Security Administration (SSA) is allowed to collect the information on this form under Sections 205 and 1106 of the Social Security Act and the Privacy Act of 1974 (5 U.S.C. § 552a). We need this information to register your company and your authorized employee(s) to use our system for verifying Social Security Numbers and to contact you, if necessary. Giving us this information is voluntary. However, without the information we will not be able to provide this service to your company. SSA may also use the information we collect on this form for such purposes authorized by law, including to ensure the appropriate use of the service.

Paperwork Reduction Act Notice

This information collection meets the clearance requirements of 44 U.S.C. 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You are not required to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take you about 5 minutes to complete this form. You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form.

Attachment B - Form SSA 89

Form Approved

OMB #0960-0760

Social Security Administration

Authorization for the Social Security Administration (SSA)

To Release

Social Security Number (SSN) Verification

Printed Name ____________________Date of Birth______________SSN ___________

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 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 (Page 1 of 2)

Privacy Act Statement

SSA is authorized to collect the information on this form under Sections 205 and 1106 of the Social Security Act and the Privacy Act of 1974 (5 U.S.C. § 552a). We need this information to provide the verification of your name and SSN to the Company and/or the Company’s Agent named on this form. Giving us this information is voluntary. However, we cannot honor your request to release this information without your consent. SSA may also use the information we collect on this form for such purposes authorized by law, including to ensure the Company and/or Company’s Agent’s appropriate use of the SSN verification service.

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/bso/cbsvPDF/agreement.pdf

Form SSA 89 (Page 2 of 2)

Attachment C - Form SSA-1235

Social Security Administration

AGREEMENT COVERING REIMBURSABLE SERVICES

JOB NUMBER

CAN:		SOC:
SSA DUNS/BPN:		SSA TAS:
SSA BETC:		SSA ALC:
SSA EIN:

REQUESTING ORGANIZATION

PROGRAM CONTACT NAME/ADDRESS

FINANCIAL CONTACT NAME/ADDRESS

ACCOUNTING DATA (for Government Agencies)

Appropriation/TAS:
ALC:
BETC:	DISB
DUNS/BPN:

EMPLOYER IDENTIFICATION NUMBER (EIN):

BEGINNING AND ENDING DATES

TYPE OF SERVICE REQUESTED

PROJECT TITLE OR KIND OF SERVICES

DESCRIPTION OF SERVICES

REFERENCES TO CORRESPONDENCE ON THIS MATTER

SSA PROJECT COORDINATOR

NAME

OFFICE

SSA CONTACT FOR INFORMATION PERTAINING TO THIS AGREEMENT

NAME

OFFICE

E STIMATED COST AND FINANCING OF SERVICES

ESTIMATED COST OF SERVICES:

FINANCING (Check one):

ADVANCE (In Full)

P AYMENT

(Quarterly)

IPAC

SSA AUTHORIZATION

PRINTED NAME

TITLE

SIGNATURE

DATE

ACCEPTANCE - FOR USE OF REQUESTING ORGANIZATION

Please provide the services requested above. We agree to pay you the full cost of such services in the amount estimated above prior to any work being performed; and we also agree to all of the terms and conditions stated in the accompanying Memorandum of Agreement.

NAME OF ORGANIZATION'S PROJECT COORDINATOR

TITLE

NAME & SIGNATURE OF AUTHORIZING OFFICIAL

TITLE

DATE

Form SSA-1235 (11-2010) Destroy Prior Editions

Attachment D - Attestation Statement (COMPANY)

ATTESTATION STATEMENT FOR

USING THE SSN VERIFICATION PROCESS

(Signature required annually)

Name and address of company requesting services:

______________________________________________________________________ ______________________________________________________________________

______________________________________________________________________

The Requesting Party understands that the Social Security Administration (SSA) will verify Social Security Numbers (SSN) solely to ensure that the records of my Clients or my Principal’s Clients are correct for the purpose(s) indicated on the Consent Forms, Form SSA-89 (Authorization for SSA to Release SSN Verification), obtained from the Clients.

The information received from records maintained by SSA is protected by Federal statutes and regulations, including 5 U.S.C. § 552a(i)(3) of the Privacy Act. Under this section, any person who knowingly and willfully requests or obtains any record concerning an individual from an agency under false pretenses shall be guilty of a misdemeanor and fined not more than $5,000.

The Requesting Party shall inform all authorized personnel with access to confidential information of the confidential nature of the information and the administrative, technical and physical safeguards required to protect the information from improper disclosure. All confidential information shall at all times be stored in an area that is physically safe from unauthorized access.

The Requesting Party shall restrict access to all confidential information to the minimum number of employees and officials who need it to perform the process.

[Please clearly print or type your Responsible Company Official's name, title, and phone number and have him/her sign and date below.]

Name_________________________________________________________________ Title__________________________________________________________________ Phone Number__________________________________________________________

Signature__________________________________________Date_________________

Attachment E - CBSV Attestation Requirements for CPA and Requesting Party Compliance Assertions

Attestation Requirements:

The examination engagement will be performed in accordance with standards applicable to attestation engagements contained in Generally Accepted Government Auditing Standards (GAGAS) issued by the Comptroller General of the United States. These standards also incorporate by reference attestation standards established by the American Institute of Certified Public Accountants. The period of the examination engagement will be the Federal fiscal year. These standards incorporate independence requirements that the CPA must meet in order to perform the examination engagement.

The examination report shall conform to attestation standards contained in GAGAS issued by the Comptroller General of the United States and attestation standards issued by the American Institute of Certified Public Accountants. GAGAS requires that the Certified Public Acountant (CPA) “…report based on the work performed, (1) significant deficiencies and material weaknesses in internal control; (2) instances of fraud and noncompliance with provisions of laws or regulations that have a material effect on the subject matter or an assertion about the subject matter and any other instances that warrant the attention of those charged with governance; (3) noncompliance with provisions of contracts or grant agreements that has a material effect on the subject matter or an assertion about the subject matter of the examination engagement; and (4) abuse that has a material effect on the subject matter or an assertion about the subject matter of the examination engagement.” GAGAS allows the findings to be reported either in the examination report or in a separate report. If the CPA reports the findings in a separate report the report which includes the findings must be submitted to the Social Security Administration (SSA) along with the examination report. All findings must be accompanied by a response from management and a corrective action plan. All findings described above must be reported to SSA. Materiality or significance standards may not be used to justify non-reporting of noncompliance.

The CPA must agree in its letter of engagement with the CBSV user to make its examination engagement work papers available for review by the Social Security Administration or its designee.

Any questions regarding the examination engagement as well as the final report on this engagement shall be directed to:

SSA

OPSOS, Agreements and Disclosure Branch

4288 Annex Building

6401 Security Blvd.

Baltimore, MD 21235-6401

Name, Email and Telephone: (will be provided when agreement is signed)

The requesting party shall provide a copy of its current CBSV User Agreement in its entirety to the reviewing CPA engaged to perform the examination.

SSA will provide to the CPA a random sample of verifications submitted by the Requesting Party identified by name, Social Security number and date of birth along with the verification results provided to the Requesting Party.

The CPA must send confirmation requests either by mail or e-mail to Social Security number holders for the sample of verifications to provide information about the validity of submitted requests. Confirmation non-replies should be followed up in writing, via mail or by phone. Results of the confirmation process will be provided in a schedule to the examination report submitted to SSA and all instances of confirmations indicating that a verification was not authorized should be included in an addendum to the examination report. The confirmation process including follow up of non-replies is a required procedure.

Terms that have a special meaning are defined in Section I.C of the CBSV User Agreement.

Requesting Party Compliance Assertions:

A signed Form SSA-89 was used to obtain consent for all verification requests submitted to SSA.

The signed Form SSA-89s used to obtain consent for social security number verification contain manual signatures of the identified individuals.

Form SSA-89s used to obtain consent contain all wording as prescribed in Attachment A of the CBSV User Agreement and no additional wording has been added.

Form SSA-89s used to obtain consent were completed in their entirety, without alterations, including name, date of birth, social security number, stated purpose principal’s name and complete address, agent (requesting party) name and telephone number, signature, date, and complete address, and phone number for the authorizing party (social security number holder).

The Agent (Requesting Party) identified on all Form SSA-89s accepted by the company is a listed party (d/b/a) in the company’s CBSV User Agreement.

Regarding the purpose stated on the Form SSA-89:

The SSN verification was used only for the purpose stated on the consent form, and

The consent form identifies a specific purpose (e.g., “mortgage application” or “verification for employment”) and is not a general purpose (e.g., “identity verification” or “identity proof or confirmation”).

The date SSN verifications were submitted to the Social Security Administration was after the date the Form SSA-89s were signed and dated.

The submission date for the SSN verification was not more than 90 days after the Form SSA-89 was signed and dated unless the authorizing individual specified an alternate timeframe. If an alternate timeframe was specified, the submission date was within the alternate timeframe.

The company retains all consent forms for seven (7) years from the date the SSN verification was submitted to the Social Security Administration.

For requesting parties that are not principals, the company has:

not informed the principal (client) of the result of the SSN verification prior to receiving the SSN verification from SSA, and
correctly relayed to the principal (client) the information regarding the SSN verification received from SSA.

The Requesting Party’s record retention policy has the following elements, if applicable:

Paper consent forms are stored in a locked fireproof container and access is limited to authorized users.

Electronic - The consent forms retained electronically, are password protected, encrypted, and only authorized personnel identified on the Form SSA-88 have access to these files. Passwords issued to personnel who no longer work for the company or no longer work in the capacity to have access to the files are voided. Paper consent forms converted to electronic media are destroyed. Disaster recovery procedures are in place and are being followed.

Removable Electronic Media - All data has been encrypted, and all removable electronic media is stored in a locked, fireproof storage receptacle. Only authorized users have access to this media. Paper consent forms have been properly destroyed after being stored electronically.

The Attestation Statement is current and the signer’s authority includes authority to financially bind the company and bear responsibility for CBSV Social Security number verification.

Form SSA-88 is current and all employees identified on the Form SSA-88s are still employed by the company and are performing CBSV duties.

For requesting parties that are not principals, the agreements between the company and its Principals (clients) include the following acknowledgements:

The Principal agrees that it shall use the verification only for the purpose stated in the Consent Form, and shall make no further use or re-disclosure of the verification.
The agreements acknowledge that Section 1140 of the Social Security Act authorizes SSA to impose civil monetary penalties on any person who uses the words "Social Security" or other program-related words, acronyms, emblems and symbols in connection with an advertisement, solicitation or other communication, "in a manner which such person knows or should know would convey, or in a manner which reasonably could be interpreted or construed as conveying, the false impression that such item is approved, endorsed, or authorized by the Social Security Administration..." 42 U.S.C. § 1320b-10(a); and

The agreements acknowledge that it is specifically prohibited from using the words "Social Security" or other program-related words, acronyms, emblems and symbols in connection with an advertisement for “identity verification”; and
The agreements further acknowledge that it is specifically prohibited from advertising that SSN verification provides or serves as identity verification; and
The agreements acknowledge that SSA has the right of access to all company books and records associated with the CBSV program at any time.
The principal agrees to follow the same requirements for safe guarding and reporting the loss of PII as outlined in Section V.B.

The requesting party’s audit trail and activity logs can track the activity of authorized users who request information or view SSA-supplied information within Requesting Party’s system, including viewing Form SSA-89s stored electronically.

Compliance/Noncompliance Standards

The following are the compliance and noncompliance standards for use in required CBSV compliance attestation engagements.

Compliance Assertion	Compliance	Noncompliance
1	Signed form provided.	Type II: Signed form not provided to auditor.
2	Manual signature on form.	Type II: Signature is printed electronically. Social security number holder confirms that SSA-89 does not represent his/her authorization of verification.
3	Form is identical to Attachment A of CBSV User Agreement	Type II: Form is altered from Attachment A of CBSV User Agreement by either added wording or deleted wording.
4	Form includes name, date of birth, Social Security number, stated purpose principal’s name, agent (requesting party) name, signature, date, and complete permanent address, and phone number for the authorizing party. Missing authorizing party phone number is acceptable if omission is explained (e.g. individual does not have phone)	Type II: Form missing any of following: name, date of birth, Social Security number, stated purpose, principal’s name, agent (requesting party) name, signature, date, and complete permanent address and phone number for the authorizing party. Type II: Form missing principal’s address, or agent phone number.
4a	The Form SSA-89 contains the signature of a parent or legal guardian if the request is for a minor child (under age 18), or of a legal guardian if the request is for a legally incompetent adult. The parent or legal guardian signed the consent and the Company retained proof of the relationship, e.g., a copy of the birth certificate or court documentation proving the relationship.	Form SSA-89 does not contain the signature of a parent or legal guardian and the request is for a minor child (under age 18), or it does not contain the signature of a legal guardian and the request is for a legally incompetent adult. The parent or legal guardian signed the consent and the Company did not retain proof of the relationship, e.g., a copy of the birth certificate or court documentation proving the relationship.
5	The Agent identified on Form SSA-89 matches the name (or doing business as (d/b/a)) listed on annual Attestation Statement filed prior to date of Form SSA-89.	Type II: The Agent identified on Form SSA-89 does not match the name (or d/b/a) listed on annual Attestation Statement filed prior to date of Form SSA-89.
6	The purpose stated on the Form SSA-89 is consistent with business of principal and is specific. Examples of a specific purpose are: mortgage loan application, verification for employment, credit card application, or seeking credit with lender.	Type II: Purpose stated on the Form SSA-89 is not specific. Examples of non-specific purpose: verify identity, confirmation, proof identity, and application. Type III: The purpose stated on the Form SSA-89 is not consistent with business of principal.
7	The date the SSN verification requested was transmitted to SSA was on or after the signature date on Form SSA-89. When the date and time the manually signed Form SSA-89 was received by the Requesting Party is available, the determination of compliance should consider time as well as date.	Type II: The submission date for the SSN verification was before the signature date on form. When the date and time the manually signed Form SSA‑89 was received by the Requesting Party is available, the determination of compliance should consider time as well as date.
8	The date the verification requested was submitted to SSA was within 90 days of the signature date on the Form SSA-89 or was within the alternate time frame if specified by authorizing individual and submission date was within alternative timeframe.	Type II: The submission date was more than 90 days after the signature date or was after the specified alternate time frame specified by the authorizing individual.
9	Form SSA-89s are available either in paper or electronic form from requesting party’s records seven years from verification date of the SSN.	Type II: Company cannot provide Form SSA-89 which authorizes a specific verification which occurred within 7 years of date Form SSA-89 is requested. Form SSA-89s which are obtained from the Principal for purposes of establishing compliance with this requirement are indicative of non-compliance with this requirement.
10	The Company has not informed Principal of results of SSN verification prior to receiving verification from SSA and the results relayed were the same as the results received from SSA.	Type II: The Company informed Principal of results of SSN verification before receiving verification from SSA based on the date and time the results were received and transmitted by the Requesting Party or the results relayed to the principal were different from the results received from SSA.
11	The Form SSA-89s retained electronically are password protected, encrypted, and only accessible by personnel identified on Form SSA-88. Passwords are deactivated when employees terminate. Paper Form SSA-89s are destroyed. Disaster recovery procedures are in place and being followed. Removable electronic media is safeguarded in a locked, fireproof storage receptacle and only authorized personnel have access.	Type II: The consent forms retained electronically are not password protected, not encrypted, or are accessible by unauthorized personnel. Passwords are not deactivated when employees terminate. Paper Form SSA-89s are not destroyed. Disaster recovery procedures are in not place and not being followed. Removable electronic media is not safeguarded in a locked, fireproof storage receptacle or unauthorized personnel have access.
12	The Attestation Statement was submitted with prior year’s examination report and the signer has authority to financially bind the company and bear responsibility.	Type II: The Attestation Statement was not submitted with prior year’s examination report and the signer does not have the authority to financially bind the company or bear responsibility.
13	During the time period that any specific Form SSA-88 was the most recent Form SSA-88 filed with SSA, all Authorized Users listed on the Form SSA-88 were employees of the Requesting Party. All Authorized Users listed on the Form SSA-88 must still be performing duties relating to the CBSV system.	During the time period that any specific Form SSA-88 was the most recent Form SSA-88 filed with SSA, an employee listed on that Form SSA-88 was not an employee of the Requesting Party. It is not considered non-compliance if the Requesting Party files a new Form SSA-88 within 14 days of the termination of employment of any employee listed as an authorized user on the Form SSA-88.
14	Agreements with Principals include: Restrictions on, and penalties for, reuse and re-disclosure; SSA’s legal authority to impose civil monetary penalties; Prohibition of using any variation of SSA in advertising; Prohibition for advertising services as identity verification; and SSA’s right to access all company books and records associated with CBSV at any time. Following the same requirements for safeguarding and reporting the loss of PII as outlined in Section V.B.	Type II: Agreements with Principals missing any of the following: Restrictions on, and penalties for, reuse and re-disclosure; SSA’s legal authority to impose civil monetary penalties; Prohibition of using any variation of SSA in advertising; Prohibition for advertising services as identity verification; and SSA’s right to access all company books and records associated with CBSV at any time. Following the same requirements for safeguarding and reporting the loss of PII as outlined in Section V.B. Reference to provisions of the Requesting Party’s User Agreement with SSA rather than specific language regarding each item listed above is considered non-compliance.
15	The company can provide an activity log that tracks the activity of employees who request information or view SSA-supplied information in the company’s system, including the Form SSA-89s stored electronically.	Type I: Failure to maintain the ability to track access to CBSV data and results, which prevents the completion of an examination engagement as required by the User Agreements. Type II: The company cannot track the activity of employees who request information or view SSA-supplied information in the company’s system, including the Form SSA-89s stored electronically.

Suspension will be lifted after the applicable penalty periods only if the requesting Party has provided evidence and SSA has determined, that the noncompliance at issue has been resolved to SSA’s satisfaction.

APPENDIX A – External Testing Environment (ETE) – (For Web Service Users Only)

OMB #0960-0760

______________________________________________________________________

CBSV User Agreement

Between the Social Security Administration (SSA)

And

External-to-SSA Developers

For External Testing Environment (ETE)

______________________________________________________________________

Purpose

The External Testing Environment (ETE) provides a dedicated test environment to be used by external-to-SSA developers for Consent Based Social Security Number Verification (CBSV) web services to test their software independent of SSA’s development activities. The ETE gives the external developers the flexibility to test on an “as needed” basis to make sure their software remains up-to-date and continues to provide accurate data on behalf of the public to SSA systems.

The purpose of this User Agreement is to establish the conditions, terms, and safeguards under which the Social Security Administration (SSA) will provide access to external-to-SSA developers for testing within the ETE.

Definitions

Name	Description
SSA	Social Security Administration
External to SSA Developer (ETSSAD)	Employee designated by Requesting Party to process submissions.
Requesting Party	Company desiring to access and use the ETE as represented by an Officer or Employee of Company possessing authority to make legally binding commitments on behalf of the Company.
Application Sponsor	Owner of SSA application with authority to approve ETSSAD request
ETE Administrator	Employee responsible for the management of the External Testing Environment
Credentials	Personal Identification Number (PIN) and Password to access SSA systems.

Technical Specifications and Systems Security & Related Business Process Requirements

The Requesting Party shall secure, at its own expense, the necessary hardware, software, etc. to establish connection to the ETE. The Requesting Party must have, and shall provide at its own expense, Internet access in order to access the ETE. The Requesting Party shall provide SSA with a valid e-mail address for its representative so that SSA may communicate with the Requesting Party via electronic mail.

All Requesting Party site preparation, connection, and operating costs, as well as any other miscellaneous costs incurred by the Requesting Party to enable its participation in the ETE, are the responsibility of the Requesting Party.

SSA shall give access to ETE documentation to the Requesting Party, which SSA may amend from time to time at its discretion without amendment to this User Agreement. The requirements for submitting files, checking status, and retrieving results are set forth in the User’s Guide.

General Participation Requirements

In order to meet general expectations for participation, the ETSSAD will need to:

Execute test scenarios over a stated period on a repetitive basis to ensure connectivity to SSA systems.
Interpret test results and accurately report issues encountered during Web service testing in enough detail that they can be reproduced.
Provide feedback to SSA regarding the application’s reliability, stability, and user experience.
Provide feedback to SSA regarding product enhancements, documentation, and help systems.
Be able to react to SSA’s software changes.
Have technical team members available to work with the SSA technical team to troubleshoot and resolve any connectivity or compatibility challenges incurred during the testing process.

Environment and Platform

In order to meet the environment requirements the ETSSAD must:

Have a Web service development environment that supports development using a .NET and/or Java-based industry standard technologies.
Have a test environment that can be setup to connect to SSA’s testing environment. If necessary, the ETSSAD test environment should be configured to use digital certificates generated by SSA for testing purposes.

Web Service Specific Expertise

The Requesting Party must have the following technical expertise in developing Web service clients for external Web services that have the following characteristics:

Conformance to the World Wide Web Consortium (W3C) Web service standards (Simple Object Access Protocol (SOAP), Web Service Definition Language (WSDL), Web Service Security [WS-Security]).
A transport layer security using Hypertext Transfer Protocol Secure (HTTPS), using Secure Socket Layer (SSL) Certificates signed by well-known Certification Authorities (CAs).
Protected Web services that require the following authentication mechanisms:

Client Authentication using the Personal Identification Number (PIN)/Password as a part of the WS-Security SOAP header, and;
Strong Authentication (using X.509 Client Certificates), which authenticates the ETSSAD based on a digital signature over the SOAP body and timestamp element.

Experience in successful Web service testing.

Ability to meet SSA’s Schedule

The ETSSAD must work within SSA’s schedule constraints. The applicant therefore must be able to:

Perform testing during the agreed-upon time frame with help support available on weekdays between 9 A.M. and 5 P.M. Eastern Standard Time (EST),
Support a flexible test schedule, and
Participate in pre-scheduled technical status conference calls for the duration of testing.

Responsibilities

Requesting Party’s Responsibilities:

The Requesting Party agrees to create electronic file(s) to be used to test an SSA developed web service. The Requesting Party may be asked to process SSA generated test data when required.

All requests will conform to the submission requirements outlined in the ETE documentation which the Requesting Party will have access to upon successful registration for access to the ETE.

The Requesting Party agrees to provide the name, phone number, email address, and timeframe for testing. Further, the Requesting Party agrees to notify SSA if there is any change to employment status (including but not limited to, for example, long-term absence, termination of employment, change of duties relevant to ETE) for any ETSSAD authorized to use ETE. The Requesting Party will also notify SSA if they wish to revoke any employee’s authorization to use SSA’s ETE. The registration process will be completed by issuance of a unique access code by SSA to the Requesting Party. The Requesting Party is required to provide this code to the ETSSAD as authentication of the employee’s relationship to the Requesting Party as well as being authorized by the Requesting Party to submit such requests.

SSA may change its method of receiving verification requests and providing the results to the Requesting Party at any time. The Requesting Party shall be responsible for any costs generated by SSA's decision to change its method of using the ETE.

Requesting Party Acknowledgements:

The Requesting Party acknowledges that Section 1140 of the Social Security Act authorizes SSA to impose civil monetary penalties on any person who uses the words "Social Security" or other program-related words, acronyms, emblems and symbols in connection with an advertisement, solicitation or other communication, "in a manner which such person knows or should know would convey, or in a manner which reasonably could be interpreted or construed as conveying, the false impression that such item is approved, endorsed, or authorized by the Social Security Administration . . . ." 42 U.S.C. § 1320b-10(a); and

The Requesting Party acknowledges that it is specifically prohibited from using the words "Social Security" or other program-related words, acronyms, emblems and symbols in connection with an advertisement for products or services; and

The Requesting Party acknowledges that the information received from records maintained by SSA is protected by Federal statutes and regulations, including 5 U.S.C. § 552a(i)(3) of the Privacy Act. Under this section, any person who knowingly and willfully requests or obtains any information from SSA under false pretenses shall be guilty of a misdemeanor and fined not more than $5,000.

Note: These acknowledgements shall extend to ETSSAD that are not the Requesting Party.

SSA’s Responsibilities:

SSA mission-related work will have priority over ETE requests on SSA’s information systems and, therefore, SSA does not guarantee that ETE request results will be available to the Requesting Party within a specified time frame. SSA’s posting of ETE request results may be delayed while SSA performs mission-related work, or while SSA performs systems maintenance.

SSA agrees to provide limited Security and Application specific Help support to ETSSAD. The intent of this support is not to troubleshoot the Requesting Party’s application, rather to verify that SSA’s environment is operational. ETSSAD are expected to develop their Web Service Definition Language (WSDL) based on documentation provided by SSA after successful registration.

Duration of Agreement and Suspension of Services

Duration of Agreement

This User Agreement is effective upon signature of the Requesting Party and issuance of security credentials and ends in the following situations:

The time frame stated by the Requesting Party during the registration process has ended, leading to the account being suspended.
SSA cancels any ETE application or the entire environment at any time. However, SSA will make a reasonable effort to provide 5 days notice prior to such action.
The Requesting Party gives notice of its decision to cancel its Agreement. In the event that the Requesting Party gives notice of its intent to cancel the Agreement, the Agreement shall terminate immediately or at the specified notice date;

SSA and the Requesting Party mutually agree to cancel the Agreement;
Cancellation of the Agreement is required by law and shall be effective as specified.

This agreement will come to an end if determined that the ETSSAD does not demonstrate the technical and environmental expertise as stated in Section III of this document.

Note: The completion of application testing within the ETE has no bearing on access to SSA Production systems. ETSSAD’s must apply for access to SSA Production systems.

Suspension of Services

Not withstanding any other provision of this Agreement, SSA may unilaterally suspend access of the Requesting Party to ETE services at the Agency’s discretion. Suspension will be effective immediately upon notice by SSA to the Requesting Party and will remain in effect until lifted by SSA. During the suspension period, notifications will be sent to all ETSSAD who have used the ETE environment on updates relating to the application tested.

The Requesting Party specifically waives any right to judicial review of SSA’s decision to suspend or cancel this Agreement.

Amendments to Agreement

Unilateral Amendments

SSA reserves the right to make the following types of unilateral amendments to this Agreement at any time:

Minor administrative changes (for example, changes to SSA mailing addresses, email addresses, names of personnel, locations, etc.); and/or
Process changes (for example, how submissions are to be received and results provided to business partners)

Unilateral amendments will be sent to the Requesting Party to notify them of the change. If the Requesting Party chooses to cancel this Agreement as a result of a unilateral amendment, notice to SSA is required.

Indemnification

Notwithstanding any other provision of this User Agreement, the Requesting Party agrees to indemnify and hold SSA harmless from all claims, actions, causes of action, suits, debts, dues, sums of money, accounts, covenants, contracts, controversies, agreements, promises, representations, restitutions, damages, costs, fees, judgments, and any other liabilities associated with, or resulting directly or indirectly from, any action, including but not limited to, actions involving the disclosure of information released by the Requesting Party. SSA shall not be responsible for any financial loss or other loss incurred by the Requesting Party, whether directly or indirectly, through the use of any data furnished pursuant to this User Agreement. SSA shall not be responsible for reimbursing the Requesting Party any costs incurred by the Requesting Party pursuant to this User Agreement.

Disclaimers

The delivery by SSA of services described herein and the timeliness of the delivery are authorized only to the extent that they are consistent with proper performance of the official duties and obligations of SSA and the relative importance of this request to others. If for any reason SSA delays or fails to provide services, or discontinues the services or any part thereof, SSA is not liable for any damages or loss resulting from such delay or for any such failure or discontinuance.

Integration

This User Agreement constitutes the entire agreement of the parties with respect to its subject matter. There have been no representations, warranties or promises made outside of this User Agreement. This User Agreement shall take precedence over any other documents that may be in conflict with it.

Resolution Mechanism

In the event of a disagreement between the parties to this User Agreement, the parties shall meet and confer to attempt to negotiate a resolution. If the parties cannot negotiate a resolution, the dispute shall be submitted in writing to the Deputy Commissioner of Systems, who will render a final determination binding on both parties.

Persons to Contact

SSA Contacts:

ETE Project Team

Electronic Mail: [email protected]

Authorizing Signatures and Dates

The signatories below warrant and represent that they have the competent authority on behalf of their respective agencies or companies to enter into the obligations set forth in this User Agreement.

____________________________________ ____________________________________
Requesting Party SSA Representative

Company

23 of 47

User Agreement Between SSA and Requesting Party for CBSV Revised 6/13

File Type	application/msword
Author	373325
Last Modified By	889123
File Modified	2013-05-20
File Created	2013-05-20

Creation of SSN Requests, Data Entry, Documentation Maintenance Etc.

Consent-Based Social Security Number Verification Service (CBSV)

CBSV User Agreement Revised Version