Form SSA-88 (04-2017)
Destroy Prior Editions
Social Security Administration
Pre-Approval Form For Consent Based
Social Security Number Verification (CBSV)
Page 1 of 2
OMB No. 0960-0760
COMPANY REGISTRATION
1. Name of the Company:
2. Company Address (P.O. Box alone is not acceptable)
Address Line 1:
Address Line 2:
City: State: Zip Code:
3. EIN (Employer Identification Number):
(Provide primary EIN if your company uses more than one.)
4. Designated email mailbox for receipt of technical bulletins from SSA:
Please note, the SSA will only send technical bulletins to one email address per company. You may provide this information later if you
do not have one now.
EMPLOYEE(S) AUTHORIZED TO USE CBSV
List the names of all employees unless your company will access CBSV solely through a web service platform.
Note: If your company will access CBSV solely through a web service platform, please provide corresponding
information of the Responsible Company Official as the employee authorized to use CBSV.
5. Name of Employee(s) Authorized to use CBSV:
6. Telephone Number of Employee(s) Authorized to use CBSV (include area code):
7. E-mail Address of Employee(s) Authorized to use CBSV:
AUTHORIZED SIGNATURE OF RESPONSIBLE COMPANY OFFICIAL
8.
Name of Responsible Company Official (print or type)
Title
Date
Telephone Number (include area code):
E-mail Address:
See SSA’s CBSV User Guide for information regarding the extent and nature of employee’s authority to use
CBSV. Notify us if your authorized employee leaves your company or if you choose to revoke any or all of your
employee's authorization to use SSA's Business Services Online (BSO).
Signature of Responsible Company Official
