New CBSV Consent Form

Please note that the Social Security Administration (SSA) has issued a new Consent Based Social Security Number Verification (CBSV) consent form effective January 1, 2018.

Clients that use CBSV as part of their screening program must use the updated CBSV Form SSA-89 (04/17 version). In order to ensure compliance with SSA requirements for this service, any previous version of a CBSV consent form cannot be accepted after January 1, 2018.

Click here to access the updated CBSV Form SSA-89 (04/17 version).

Please be sure to pre-populate the following employer-required fields prior to distributing the CBSV consent form to applicants or employees:

• Company Name
• Company Address

Applicants must complete all of the following fields to process a CBSV request:

• Printed Name
• Date of Birth
• Social Security Number
• Days Consent Valid with initials
• Signature
• Date Signed
• Full Address
• Phone Number

IMPORTANT: As a reminder, both pages of Form SSA-89 (04/17) must be provided with your request in order to be processed.

Also note, if the applicant is under the age of 18, a parent/guardian must provide consent and proof of relationship (i.e. child’s birth certificate, adoption record or valid court document).

As a reminder, SSA does not accept electronic/digital signatures on Form SSA-89. The revised (04/17) version of Form SSA-89 still requires a wet “pen and ink” signature.