Attestation Statement For Ssa Form 89 Page 2

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11) We acknowledge that SSA has the right of access to all company books and records associated with our use of the CBSV program
at any time.
12) We understand that CBSV does not verify employment eligibility, nor does it interface with the Department of Homeland
Security (DHS) verification system, and it will not satisfy DHS’s I-9 requirements.”
As the official within our company responsible for utilizing the SSN verification service, I have read and understood our obligations.
My name, title, phone and signature follows:
Name___________________________________________________________________
Title____________________________________________________________________
Phone Number_________________________ Email _____________________________
Signature___________________________________________Date_________________
End of Form [version 20100514a]

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