Storing Consent Forms

SSA will insert the following revised Privacy Act Statement into the form as soon
as possible:
Privacy Act Statement
Collection and Use of Personal Information

Sections 205(a) and 1106 of the Social Security Act, as amended, allow us to collect this
information. Furnishing us this information is voluntary. However, failing to provide all or part
of the information may prevent us from providing consent-based Social Security number
verifications (CBSV) to your company. We will use the information to register your company
and authorized employees for CBSV use. In addition, we may use the information for purposes
authorized by law including to ensure the appropriate use of CBSV.