Form Ssa 89 - Social Security Administration Authorization For The Social Security Administration (Ssa)

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Consent Based SSN Verification (CBSV)
Form SSA-89 Instructions
The SSA-89 Form must be filled out completely and legibly.
All SSA-89 Forms must be signed by the subject.
No modifications can be made to the SSA-89 Form.
CBSV searches cannot be processed until IntelliCorp receives a completed SSA-89 Form.
(216) 450-5251
CBSV@intellicorp.net
Completed forms must be faxed to:
or emailed to:
Any SSA-89 form that does not follow these guidelines CANNOT be accepted by
IntelliCorp and will be returned to the client with instructions to resubmit.
This will delay processing.
Required Information Checklist and Tips:
Printed Name
Include the name exactly as it was submitted in the website search.
Example: If Joseph Jones was submitted, Joe Jones will be rejected.
Date of Birth
Include the date of birth exactly as it was submitted in the website search.
SSN
Include the SSN exactly as it was submitted in the website search.
Reason(s) for using
You must select one or more of the provided reasons.
CBSV
Company Name
Make sure company information is complete and accurate. Include a
street address, city, state and zip code.
Company Address
Signature
The form must be signed and dated by the subject.
This must be a physical (wet) signature.
Contact Information
Address
City/State/Zip
All information must be filled out completely and legibly.
Phone Number

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