Completing Form SSA-89

Consent-Based Social Security Number Verification Service (CBSV)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0760 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-89 Completing Form SSA-89 Form
SSA-89 Authroiztion for the Social Security Administration to R SSA-89.pdf Form

Information Collection (IC) Details

IC Title:	Completing Form SSA-89	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 401.100

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-89	Authroiztion for the Social Security Administration to Release SSN Verification	SSA-89.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,700,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,700,000	298,294	2,401,706
Annual IC Time Burden (Hours)	202,500	85,162	117,338
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.