Page 1 of 25 E-Verify MOU for Employers Using a Web Services E-Verify Employer Agent | Revision Date 06/01/13
Company ID Number: Client Company ID Number:
THE E-VERIFY
MEMORANDUM OF UNDERSTANDING
FOR EMPLOYERS USING A WEB SERVICES E-VERIFY EMPLOYER AGENT
ARTICLE I
PURPOSE AND AU
THORITY
E-Verify is a program tha
t electronically confirms an employee’s eligibility to work in the United States
after completion of Form I-9, Employment Eligibility Verification (Form I-9). This Memorandum of
Understanding (MOU) explains certain features of the E-Verify program and describes specific
responsibilities of the Employer, the E-Verify Employer Agent, the Social Security Administration (SSA),
and DHS.
References in this MOU to the Employer include the Web Services E-Verify Employer Agent when
acting on behalf of the Employer.
For purposes of this MOU, the E-Ve
rify browser refers to the website that provides direct access to the
E-Verify system: https://e-verify.uscis.gov/emp/
. You may access E-Verify directly free of charge via
the E-Verify browser.
Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and
Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C.
§ 1324a note). The Federal Acquisition Regulation (FAR) Subpart 22.18, “Employment Eligibility
Verification” and Executive Order 12989, as amended, provide authority for Federal contractors and
subcontractors (Federal contractor) to use E-Verify to verify the employment eligibility of certain
employees working on Federal contracts.
ARTICLE II
RESPONSIBILITIES
A. RESPONSIBILITIES OF TH
E EMPLOYER
For purposes of this MOU, references to the Employer include the Web Services E-Verify Employer
Agent when acting on behalf of the Employer.
1. By enrolling in E-Verify and signing the applicable MOU, the Employer asserts that it is a legitimate
company which intends to use E-Verify for legitimate purposes only and in accordance with the laws,
regulations and DHS policies and procedures relating to the use of E-Verify.
The parties to this agreement are the Department of Homeland Security (DHS), the <employer_name>
(Employer), and the Web Services E-Verify Employer Agent. The purpose of this agreement is to set
forth terms and conditions which the Employer and the Web Services E-Verify Employer Agent will
follow while participating in E-Verify.
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2. The Em
ployer agrees to display the following notices supplied by DHS (though the Web Services E-
Verify Employer Agent) in a prominent place that is clearly visible to prospective employees and all
employees who are to be verified through the system:
a. Notice of E-Verify Participation
b. Notice of Right to Work
3. The Employer agrees to provide to the SSA and DHS the names, titles, addresses, and telephone
numbers of the Employer representatives to be contacted about E-Verify. The Employer also agrees to
keep such information current by providing updated information to SSA and DHS whenever the
representatives’ contact information changes.
4. The Employer agrees to become familiar with and comply with the most recent version of the
E-Verify User Manual. The Employer will obtain the E-Verify User Manual from the Web Services
E-Verify Employer Agent, and will be notified by the Web Services E-Verify Employer Agent when a
new version of the E-Verify User Manual becomes available.
5. The Employer agrees to comply with current Form I-9 procedures, with two exceptions:
a. If an employee presents a "List B" identity document, the Employer agrees to only accept "List
B" documents that contain a photo. (List B documents identified in 8 C.F.R. 274a.2(b)(1)(B)) can be
presented during the Form I-9 process to establish identity.) If an employee objects to the photo
requirement for religious reasons, the Employer should contact E-Verify at 888-464-4218.
b. If an employee presents a DHS Form I-551 (Permanent Resident Card), Form I-766
(Employment Authorization Document), or U.S. Passport or Passport Card to complete
Form I-9, the Employer agrees to make a photocopy of the document and to retain the photocopy
with the employee’s Form I-9. The Employer will use the photocopy to verify the photo and to assist
DHS with its review of photo mismatches that employees contest. DHS may in the future designate
other documents that activate the photo screening tool.
Note: Subject only to the exceptions noted previously in this paragraph, employees still retain the right
to present any List A, or List B and List C, document(s) to complete the Form I-9.
6. The Employer agrees to record the case verification number on the employee's Form I-9 or to print
the screen containing the case verification number and attach it to the employee's Form I-9.
7. The Employer agrees that, although it participates in E-Verify, the Employer has a responsibility to
complete, retain, and make available for inspection Forms I-9 that relate to its employees, or from other
requirements of applicable regulations or laws, including the obligation to comply with the
antidiscrimination requirements of section 274B of the INA with respect to Form I-9 procedures.
a. The following modified requirements are the only exceptions to an Employer’s obligation to not
employ unauthorized workers and comply with the anti-discrimination provision of the INA: (1) List B
identity documents must have photos, as described in paragraph 6 above; (2) When an Employer
confirms the identity and employment eligibility of newly hired employee using E-Verify procedures,
the Employer establishes a rebuttable presumption that it has not violated section 274A(a)(1)(A) of
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the Immi
gration and Nationality Act (INA) with respect to the hiring of that employee; (3) If the
Employer receives a final nonconfirmation for an employee, but continues to employ that person,
the Employer must notify DHS and the Employer is subject to a civil money penalty between $550
and $1,100 for each failure to notify DHS of continued employment following a final
nonconfirmation; (4) If the Employer continues to employ an employee after receiving a final
nonconfirmation, then the Employer is subject to a rebuttable presumption that it has knowingly
employed an unauthorized alien in violation of section 274A(a)(1)(A); and (5) no E-Verify participant
is civilly or criminally liable under any law for any action taken in good faith based on information
provided through the E-Verify.
b. DHS reserves the right to conduct Form I-9 compliance inspections, as well as any other
enforcement or compliance activity authorized by law, including site visits, to ensure proper use of
E-Verify.
8. The Employer is strictly prohibited from creating an E-Verify case before the employee has been
hired, meaning that a firm offer of employment was extended and accepted and Form I-9 was
completed. The Employer agrees to create an E-Verify case for new employees within three Employer
business days after each employee has been hired (after both Sections 1 and 2 of Form I-9 have been
completed), and to complete as many steps of the E-Verify process as are necessary according to the
E-Verify User Manual. If E-Verify is temporarily unavailable, the three-day time period will be extended
until it is again operational in order to accommodate the Employer's attempting, in good faith, to make
inquiries during the period of unavailability.
9. The Employer agrees not to use E-Verify for pre-employment screening of job applicants, in support
of any unlawful employment practice, or for any other use that this MOU or the E-Verify User Manual
does not authorize.
10. The Employer must use E-Verify (through its Web Services E-Verify Employer Agent) for all new
employees. The Employer will not verify selectively and will not verify employees hired before the
effective date of this MOU. Employers who are Federal contractors may qualify for exceptions to this
requirement as described in Article II.B of this MOU.
11. The Employer agrees to follow appropriate procedures (see Article III below) regarding tentative
nonconfirmations. The Employer must promptly notify employees in private of the finding and provide
them with the notice and letter containing information specific to the employee’s E-Verify case. The
Employer agrees to provide both the English and the translated notice and letter for employees with
limited English proficiency to employees. The Employer agrees to provide written referral instructions
to employees and instruct affected employees to bring the English copy of the letter to the SSA. The
Employer must allow employees to contest the finding, and not take adverse action against employees
if they choose to contest the finding, while their case is still pending. Further, when employees contest
a tentative nonconfirmation based upon a photo mismatch, the Employer must take additional steps
(see Article III.B below) to contact DHS with information necessary to resolve the challenge.
12. The Employer agrees not to take any adverse action against an employee based upon the
employee's perceived employment eligibility status while SSA or DHS is processing the verification
request unless the Employer obtains knowledge (as defined in 8 C.F.R. § 274a.1(l)) that the employee
is not work authorized. The Employer understands that an initial inability of the SSA or DHS automated
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verifi
cation system to verify work authorization, a tentative nonconfirmation, a case in continuance
(indicating the need for additional time for the government to resolve a case), or the finding of a photo
mismatch, does not establish, and should not be interpreted as, evidence that the employee is not work
authorized. In any of such cases, the employee must be provided a full and fair opportunity to contest
the finding, and if he or she does so, the employee may not be terminated or suffer any adverse
employment consequences based upon the employee’s perceived employment eligibility status
(including denying, reducing, or extending work hours, delaying or preventing training, requiring an
employee to work in poorer conditions, withholding pay, refusing to assign the employee to a Federal
contract or other assignment, or otherwise assuming that he or she is unauthorized to work) until and
unless secondary verification by SSA or DHS has been completed and a final nonconfirmation has
been issued. If the employee does not choose to contest a tentative nonconfirmation or a photo
mismatch or if a secondary verification is completed and a final nonconfirmation is issued, then the
Employer can find the employee is not work authorized and terminate the employee’s employment.
Employers or employees with questions about a final nonconfirmation may call E-Verify at 1-888-464-
4218 (customer service) or 1-888-897-7781 (worker hotline).
13. The Employer agrees to comply with Title VII of the Civil Rights Act of 1964 and section 274B of
the INA as applicable by not discriminating unlawfully against any individual in hiring, firing,
employment eligibility verification, or recruitment or referral practices because of his or her national
origin or citizenship status, or by committing discriminatory documentary practices. The Employer
understands that such illegal practices can include selective verification or use of E-Verify except as
provided in part D below, or discharging or refusing to hire employees because they appear or sound
“foreign” or have received tentative nonconfirmations. The Employer further understands that any
violation of the immigration-related unfair employment practices provisions in section 274B of the INA
could subject the Employer to civil penalties, back pay awards, and other sanctions, and violations of
Title VII could subject the Employer to back pay awards, compensatory and punitive damages.
Violations of either section 274B of the INA or Title VII may also lead to the termination of its
participation in E-Verify. If the Employer has any questions relating to the anti-discrimination provision,
it should contact OSC at 1-800-255-8155 or 1-800-237-2515 (TDD).
14. The Employer agrees that it will use the information it receives from E-Verify (through its Web
Services E-Verify Employer Agent) only to confirm the employment eligibility of employees as
authorized by this MOU. The Employer agrees that it will safeguard this information, and means of
access to it (such as Personal Identification Numbers and passwords), to ensure that it is not used for
any other purpose and as necessary to protect its confidentiality, including ensuring that it is not
disseminated to any person other than employees of the Employer who are authorized to perform the
Employer's responsibilities under this MOU, except for such dissemination as may be authorized in
advance by SSA or DHS for legitimate purposes.
15. The Employer agrees to notify DHS immediately in the event of a breach of personal information.
Breaches are defined as loss of control or unauthorized access to E-Verify personal data. All suspected
or confirmed breaches should be reported by calling 1-888-464-4218 or via email at E-Verify@dhs.gov
.
Please use “Privacy Incident Password” in the subject line of your email when sending a breach
report to E-Verify.
16. The Employer acknowledges that the information it receives from SSA through its Web Services
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E-Verify E
mployer Agent is governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social
Security Act (42 U.S.C. 1306(a)). Any person who obtains this information under false pretenses or
uses it for any purpose other than as provided for in this MOU may be subject to criminal penalties.
17. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and
evaluation of E-Verify, which includes permitting DHS, SSA, their contractors and other agents, upon
reasonable notice, to review Forms I-9 and other employment records and to interview it and its
employees regarding the Employer’s use of E-Verify, and to respond in a prompt and accurate manner
to DHS requests for information relating to their participation in E-Verify.
18. The Employer shall not make any false or unauthorized claims or references about its participation
in E-Verify on its website, in advertising materials, or other media. The Employer shall not describe its
services as federally-approved, federally-certified, or federally-recognized, or use language with a
similar intent on its website or other materials provided to the public. Entering into this MOU does not
mean that E-Verify endorses or authorizes your E-Verify services and any claim to that effect is false.
19. The Employer shall not state in its website or other public documents that any language used
therein has been provided or approved by DHS, USCIS or the Verification Division, without first
obtaining the prior written consent of DHS.
20. The Employer agrees that E-Ve
rify trademarks and logos may be used only under license by
DHS/USCIS (see M-795 (Web)
) and, other than pursuant to the specific terms of such license, may not
be used in any manner that might imply that the Employer’s services, products, websites, or
publications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E-Verify.
21. The Employer understands that if it uses E-Verify procedures for any purpose other than as
authorized by this MOU, the Employer may be subject to appropriate legal action and termination of its
participation in E-Verify according to this MOU.
B. RESPONSIBILITIES OF THE WEB SERVICES E-VERIFY EMPLOYER AGENT
1. The Web Services E-Verify Employer Agent agrees to complete its Web Services interface no later
than six months after the date the Web Services User signs this MOU. E-Verify considers your
interface to be complete once it has been built pursuant to the Interface Control Agreement (ICA),
submitted to E-Verify for testing, and approved for system access.
2. The Web Services E-Verify Employer Agent agrees to perform sufficient maintenance on the Web
Services interface in accordance with the requirements listed in the ICA. These requirements include,
but are not limited to, updating the Web Services interface to ensure that any updates or
enhancements are incorporated no later than six months after the issuance of an ICA. Web Services
E-Verify Employer Agents should be aware that this will require the investment of time and resources.
Compliance with the requirements of the ICA must be carried out to the satisfaction of DHS and or its
assignees.
3. The Web Services E-Verify Employer Agent agrees to provide to SSA and/or DHS the names, titles,
addresses, e-mail addresses, and telephone numbers of the Web Services E-Verify Employer Agent
representative who will access information, as well as ensure cooperation, communication, and
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coordination w
ith E-Verify. In addition, Web Services E-Verify Employer Agents must provide to SSA
and/or DHS the names, titles, addresses, and telephone numbers of its clients and their staff who will
access information through E-Verify. Web Services E-Verify Employer Agents must ensure the contact
information is updated with SSA and DHS whenever the points of contact change.
4. The Web Services E-Verify Employer Agent agrees to become familiar with and comply with the
E-Verify User Manual and provide a copy of the most current version of the manual to the Employer so
that the Employer can become familiar with and comply with E-Verify policy and procedures. The Web
Services E-Verify Employer Agent agrees to obtain a revised E-Verify User Manual as it becomes
available and to provide a copy of the revised version to the Employer no later than 30 days after the
manual becomes available.
5. The Web Services E-Verify Employer Agent agrees that any person accessing E-Verify on its behalf
is trained on the most recent E-Verify policy and procedures.
6. The Web Services E-Verify Employer Agent agrees that any of its representatives who will
perform employment verification cases will complete the E-Verify Tutorial before that individual initiates
any cases.
a. The Web Services E-Verify Employer Agent agrees that all of its representatives will take the
refresher tutorials initiated by E-Verify as a condition of continued use of E-Verify, including any
tutorials for Federal contractors, if any of the Employers represented by the Web Services E-Verify
Employer Agent is a Federal contractor.
b. Failure to complete a refresher tutorial will prevent the Web Services E-Verify Employer
Agent and Employer from continued use of E-Verify.
7. The Web Services E-Verify Employer Agent agrees to grant E-Verify access only to current
employees who need E-Verify access. The Web Services E-Verify Employer Agent must promptly
terminate an employee’s E-Verify access if the employee is separated from the company or no longer
needs access to E-Verify.
8. The Web Services E-Verify Employer Agent agrees to obtain the necessary equipment to use
E- Verify as required by the E-Verify rules and regulations as modified from time to time.
9. The Web Services E-Verify Employer Agent agrees to, consistent with applicable laws, regulations,
and policies, commit sufficient personnel and resources to meet the requirements of this MOU.
10. The Web Services E-Verify Employer Agent agrees to provide its clients with training on E-Verify
processes, policies, and procedures. The E-Verify Employer Agent also agrees to provide its clients
with ongoing E-Verify training as needed. E-Verify is not responsible for providing training to clients of
E-Verify Employer Agents.
11. The Web Services E-Verify Employer Agent agrees to provide the Employer with the notices
described in Article II.B.2 below.
12. The Web Serv
ices E-Verify Employer Agent agrees to create E-Verify cases for the Employer it
represents in accordance with the E-Verify Manual, the E-Verify Web-Based Tutorial and all other
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published E-V
erify rules and procedures. The Web Services E-Verify Employer Agent will create
E-Verify cases using information provided by the Employer and will immediately communicate the
response back to the Employer. If E-Verify is temporarily unavailable, the three-day time period will
be extended until it is again operational in order to accommodate the Web Services E-Verify Employer
Agent’s attempting, in good faith, to make inquiries on behalf of the Employer during the period of
unavailability. If, however, the Web Services interface is unavailable due to no fault of E-Verify, then the
three-day time period is not extended. In such a case, the Web Services E-Verify Employer Agent
must use the E-Verify browser during the outage.
13. The Web Services E-Verify Employer Agent agrees to ensure that all notices, referral letters and
any other materials otherwise including instructions regarding tentative nonconfirmations, will be
consistent with the most current E-Verify tentative nonconfirmation notices and referral letters, which
are available on E-Verify’s website.
14. The Web Services E-Verify Employer Agent agrees that any system or interface it develops will
follow the steps for creating E-Verify cases and processing tentative nonconfirmations, as laid out in the
ICA, this MOU and the User Manual, including but not limited to allowing an employer to close an
invalid case where appropriate, allowing an employer to refer a tentative nonconfirmation only when an
employee chooses to contest a tentative nonconfirmation (no automatic referrals), and referring a
tentative nonconfirmation to the appropriate agency at the time the employer prints the referral letter
and provides the letter to the employee. The Web Services E-Verify Employer Agent understands that
any failure to make its system or interface consistent with proper E-Verify procedures can result in DHS
terminating the Web Services E-Verify Employer Agent’s agreement and access with or without notice.
15. When the Web Services E-Verify Employer Agent receives notice from a client company that it has
received a contract with the FAR clause, then the Web Services E-Verify Employer Agent must update
the company’s E-Verify profile within 30 days of the contract award date.
16. If data is transmitted between the Web Services E-Verify Employer Agent and its client, then the
Web Services E-Verify Employer Agent agrees to protect personally identifiable information during
transmission to and from the Web Services E-Verify Employer Agent.
17. The Web Services E-V
erify Employer Agent agrees to notify DHS immediately in the event of a
breach of personal information. Breaches are defined as loss of control or unauthorized access to
E-Verify personal data. All suspected or confirmed breaches should be reported by calling 1-888-464-
4218 or via email at E-Verify@dhs.gov
. Please use “Privacy Incident Password” in the subject line of
your email when sending a breach report to E-Verify.
18. The Web Services E-Verify Employer Agent agrees to fully cooperate with DHS and SSA in their
compliance monitoring and evaluation of E-Verify, including permitting DHS, SSA, their contractors
and other agents, upon reasonable notice, to review Forms I-9, employment records, and all records
pertaining to the Web Services E-Verify Employer Agent’s use of E-Verify, and to interview it and its
employees regarding the use of E-Verify, and to respond in a timely and accurate manner to DHS
requests for information relating to their participation in E-Verify.
a. The Web Services E-Verify Employer Agent agrees to cooperate with DHS if DHS requests
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inform
ation about the Web Services E-Verify Employer Agent’s interface, including requests by
DHS to view the actual interface operated by the Web Services E-Verify Employer Agent as well as
related business documents. The Web Services E-Verify Employer Agent agrees to demonstrate
for DHS the functionality of its interface to E-Verify upon request.
b. The Web Services E-Verify Employer Agent agrees to demonstrate, if requested by DHS, that
it has provided training to its clients that meets E-Verify standards. Training programs must provide
a focused study of the topics covered in the E-Verify User Manual and pertinent Supplemental
Guides. Furthermore, training programs and materials must be updated as E-Verify changes occur.
The Web Services E-Verify Employer Agent is encouraged to incorporate information from existing
E-Verify materials, including the Enrollment Quick Reference Guide, the E-Verify Employer Agent
Client Handbook (formerly known as the Designated Agent Client Handbook), and existing tutorials
and manuals into their training program. E-Verify also encourages the Web Services E-Verify
Employer Agent to supervise first-time use of the E-Verify browser or Web Services interface by its
staff and Employer clients as part of any training program. The Web Services E-Verify Employer
Agent agrees to submit its training program materials to DHS for review upon request.
Failure to provide adequate training could, in some instances, lead to penalties as described in Article
V.F.1. of this MOU.
19. The Web Services E-Verify Employer Agent shall not make any false or unauthorized claims or
references about its participation in E-Verify on its website, in advertising materials, or other media.
The Web Services E-Verify Employer Agent shall not describe its services as federally-approved,
federally-certified, or federally-recognized, or use language with a similar intent on its website or other
materials provided to the public. Entering into this MOU does not mean that E-Verify endorses or
authorizes your Web Services E-Verify Employer Agent services and any claim to that effect is false.
20. The Web Services E-Verify Employer Agent shall not state in its website or other public documents
that any language used therein has been provided or approved by DHS, USCIS or the Verification
Division, without first obtaining the prior written consent of DHS.
21. T
he Web Services E-Verify Employer Agent agrees that E-Verify trademarks and logos may be
used only under license by DHS/USCIS (see M-795 (Web)
) and, other than pursuant to the specific
terms of such license, may not be used in any manner that might imply that the Web Services E-Verify
Employer Agent’s services, products, websites, or publications are sponsored by, endorsed by,
licensed by, or affiliated with DHS, USCIS, or E-Verify.
22. The Web Services E-Verify Employer Agent understands that if it uses E-Verify procedures for any
purpose other than as authorized by this MOU, the Web Services E-Verify Employer Agent may be
subject to appropriate legal action and termination of its participation in E-Verify according to this MOU.
C. RESPONSIBILITIES OF FEDERAL CONTRACTORS
The Web Services E-Verify Employer Agent shall ensure that the Web Services E-Verify Employer
Agent and the Employers it represents carry out the following responsibilities if the Employer is a
Federal contractor or becomes a federal contractor. The Web Services E-Verify Employer Agent
should instruct the client to keep the Web Services E-Verify Employer Agent informed about any
changes or updates related to federal contracts. It is the Web Services E-Verify Employer Agent’s
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responsi
bility to ensure that its clients are in compliance with all E-Verify policies and procedures.
1. If the Employer is a Federal contractor with the FAR E-Verify clause subject to the employment
verification terms in Subpart 22.18 of the FAR, it will become familiar with and comply with the most
current version of the E-Verify User Manual for Federal Contractors as well as the E-Verify
Supplemental Guide for Federal Contractors.
2. In addition to the responsibilities of every employer outlined in this MOU, the Employer understands
that if it is a Federal contractor subject to the employment verification terms in Subpart 22.18 of the
FAR it must verify the employment eligibility of any “employee assigned to the contract” (as defined in
FAR 22.1801). Once an employee has been verified through E-Verify by the Employer, the Employer
may not reverify the employee through E-Verify.
a. An Employer that is not enrolled in E-Verify as a Federal contractor at the time of a contract
award must enroll as a Federal contractor in the E-Verify program within 30 calendar days of
contract award and, within 90 days of enrollment, begin to verify employment eligibility of new hires
using E-Verify. The Employer must verify those employees who are working in the United States,
whether or not they are assigned to the contract. Once the Employer begins verifying new hires,
such verification of new hires must be initiated within three business days after the hire date. Once
enrolled in E-Verify as a Federal contractor, the Employer must begin verification of employees
assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an
employee’s assignment to the contract, whichever date is later.
b. Employers enrolled in E-Verify as a Federal contractor for 90 days or more at the time of a
contract award must use E-Verify to begin verification of employment eligibility for new hires of the
Employer who are working in the United States, whether or not assigned to the contract, within
three business days after the date of hire. If the Employer is enrolled in E-Verify as a Federal
contractor for 90 calendar days or less at the time of contract award, the Employer must, within 90
days of enrollment, begin to use E-Verify to initiate verification of new hires of the contractor who
are working in the United States, whether or not assigned to the contract. Such verification of new
hires must be initiated within three business days after the date of hire. An Employer enrolled as a
Federal contractor in E-Verify must begin verification of each employee assigned to the contract
within 90 calendar days after date of contract award or within 30 days after assignment to the
contract, whichever is later.
c. Federal contractors that are institutions of higher education (as defined at 20 U.S.C. 1001(a)),
state or local governments, governments of Federally recognized Indian tribes, or sureties
performing under a takeover agreement entered into with a Federal agency under a performance
bond may choose to only verify new and existing employees assigned to the Federal contract. Such
Federal contractors may, however, elect to verify all new hires, and/or all existing employees hired
after November 6, 1986. Employers in this category must begin verification of employees assigned
to the contract within 90 calendar days after the date of enrollment or within 30 days of an
employee’s assignment to the contract, whichever date is later.
d. Upon enrollment, Employers who are Federal contractors may elect to verify employment
eligibility of all existing employees working in the United States who were hired after November 6,
1986, instead of verifying only those employees assigned to a covered Federal contract. After
enrollment, Employers must elect to verify existing staff following DHS procedures and begin
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E-Verify verification of all existing employees within 180 days after the election.
e. The Employer may use a previously completed Form I-9 as the basis for creating an E-Verify
case for an employee assigned to a contract as long as:
i. That Form I-9 is complete (including the SSN) and complies with Article II.A.6,
ii. The employee’s work authorization has not expired, and
iii. The Employer has reviewed the information reflected in the Form I-9 either in person or
in communications with the employee to ensure that the employee’s Section 1, Form I-9
attestation has not changed (including, but not limited to, a lawful permanent resident
alien having become a naturalized U.S. citizen).
f. The Employer shall complete a new Form I-9 consistent with Article II.A.6 or update the
previous Form I-9 to provide the necessary information if:
i. The Employer cannot determine that Form I-9 complies with Article II.A.6,
ii. The employee’s basis for work authorization as attested in Section 1 has expired or
changed, or
iii. The Form I-9 contains no SSN or is otherwise incomplete.
Note: If Section 1 of Form I-9 is otherwise valid and up-to-date and the form otherwise complies
with Article II.C.5, but reflects documentation (such as a U.S. passport or Form I-551) that expired
after completing Form I-9, the Employer shall not require the production of additional
documentation, or use the photo screening tool described in Article II.A.5, subject to any additional
or superseding instructions that may be provided on this subject in the E-Verify User Manual.
g. The Employer agrees not to require a second verification using E-Verify of any assigned
employee who has previously been verified as a newly hired employee under this MOU or to
authorize verification of any existing employee by any Employer that is not a Federal contractor
based on this Article.
3. The Employer understands that if it is a Federal contractor, its compliance with this MOU is a
performance requirement under the terms of the Federal contract or subcontract, and the Employer
consents to the release of information relating to compliance with its verification responsibilities under
this MOU to contracting officers or other officials authorized to review the Employer’s compliance with
Federal contracting requirements.
D. RESPONSIBILITIES OF SSA
1. SSA agrees to allow DHS to compare data provided by the Employer (through the E-Verify
Employer Agent) against SSA’s database. SSA sends DHS confirmation that the data sent either
matches or does not match the information in SSA’s database.
2. SSA agrees to safeguard the information the Employer provides (through the E-Verify Employer
Agent) through E-Verify procedures. SSA also agrees to limit access to such information, as is
appropriate by law, to individuals responsible for the verification of Social Security numbers or
responsible for evaluation of E-Verify or such other persons or entities who may be authorized by SSA
as governed by the Privacy Act (5 U.S.C. § 552a), the Social Security Act (42 U.S.C. 1306(a)), and
SSA regulations (20 CFR Part 401).
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3. SSA a
grees to provide case results from its database within three Federal Government work days of
the initial inquiry. E-Verify provides the information to the E-Verify Employer Agent.
4. SSA agrees to update SSA records as necessary if the employee who contests the SSA tentative
nonconfirmation visits an SSA field office and provides the required evidence. If the employee visits an
SSA field office within the eight Federal Government work days from the date of referral to SSA, SSA
agrees to update SSA records, if appropriate, within the eight-day period unless SSA determines that
more than eight days may be necessary. In such cases, SSA will provide additional instructions to the
employee. If the employee does not visit SSA in the time allowed, E-Verify may provide a final
nonconfirmation to the E-Verify Employer Agent.
Note: If an Employer experiences technical problems, or has a policy question, the employer should
contact E-Verify at 1-888-464-4218.
E. RESPONSIBILITIES OF DHS
1. DHS agrees to provide the Employer with selected data from DHS databases to enable the
Employer (through the E-Verify Employer Agent) to conduct, to the extent authorized by this MOU:
a. Automated verification checks on alien employees by electronic means, and
b. Photo verification checks (when available) on employees.
2. DHS agrees to assist the E-Verify Employer Agent with operational problems associated with its
participation in E-Verify. DHS agrees to provide the E-Verify Employer Agent names, titles, addresses,
and telephone numbers of DHS representatives to be contacted during the E-Verify process.
3. DHS agrees to provide to the E-Verify Employer Agent with access to E-Verify training materials as
well as an E-Verify User Manual that contain instructions on E-Verify policies, procedures, and
requirements for both SSA and DHS, including restrictions on the use of E-Verify.
4. DHS agrees to train E-Verify Employer Agents on all important changes made to E-Verify through
the use of mandatory refresher tutorials and updates to the E-Verify User Manual. Even without
changes to E-Verify, DHS reserves the right to require E-Verify Employer Agents to take mandatory
refresher tutorials.
5. DHS agrees to provide to the Employer (through the E-Verify Employer Agent) a notice, which
indicates the Employer's participation in E-Verify. DHS also agrees to provide to the Employer anti-
discrimination notices issued by the Office of Special Counsel for Immigration-Related Unfair
Employment Practices (OSC), Civil Rights Division, U.S. Department of Justice.
6. DHS agrees to issue each of the E-Verify Employer Agent’s E-Verify users a unique user
identification number and password that permits them to log in to E-Verify.
7. DHS agrees to safeguard the information the Employer provides (through the E-Verify Employer
Agent), and to limit access to such information to individuals responsible for the verification process, for
evaluation of E-Verify, or to such other persons or entities as may be authorized by applicable law.
Information will be used only to verify the accuracy of Social Security numbers and employment
eligibility, to enforce the INA and Federal criminal laws, and to administer Federal contracting
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requ
irements.
8. DHS agrees to provide a means of automated verification that provides (in conjunction with SSA
verification procedures) confirmation or tentative nonconfirmation of employees' employment eligibility
within three Federal Government work days of the initial inquiry.
9. DHS agrees to provide a means of secondary verification (including updating DHS records) for
employees who contest DHS tentative nonconfirmations and photo mismatch tentative
nonconfirmations. This provides final confirmation or nonconfirmation of the employees' employment
eligibility within 10 Federal Government work days of the date of referral to DHS, unless DHS
determines that more than 10 days may be necessary. In such cases, DHS will provide additional
verification instructions.
ARTICLE III
REFERRAL OF INDIVIDUALS TO SSA AND DHS
A. REFERRAL TO SSA
1. If the Employer receives a tentative nonconfirmation issued by SSA, the Employer must print the
notice as directed by E-Verify. The Employer must promptly notify employees in private of the finding
and provide them with the notice and letter containing information specific to the employee’s E-Verify
case. The Employer also agrees to provide both the English and the translated notice and letter for
employees with limited English proficiency to employees. The Employer agrees to provide written
referral instructions to employees and instruct affected employees to bring the English copy of the letter
to the SSA. The Employer must allow employees to contest the finding, and not take adverse action
against employees if they choose to contest the finding, while their case is still pending.
2. The Employer agrees to obtain the employee’s response about whether he or she will contest the
tentative nonconfirmation as soon as possible after the Employer receives the tentative
nonconfirmation. Only the employee may determine whether he or she will contest the tentative
nonconfirmation.
3. After a tentative nonconfirmation, the Employer will refer employees to SSA field offices only as
directed by E-Verify. The Employer must record the case verification number, review the employee
information submitted to E-Verify to identify any errors, and find out whether the employee contests the
tentative nonconfirmation. The Employer will transmit the Social Security number, or any other
corrected employee information that SSA requests, to SSA for verification again if this review indicates
a need to do so.
4. The Employer will instruct the employee to visit an SSA office within eight Federal Government work
days. SSA will electronically transmit the result of the referral to the Employer within 10 Federal
Government work days of the referral unless it determines that more than 10 days is necessary.
5. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case
updates.
6. The Employer agrees not to ask the employee to obtain a printout from the Social Security
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Administration number database (the Numident) or other written verification of the SSN from the SSA.
B. R
EFERRAL TO DHS
1. If the Employer receives a tentative nonconfirmation issued by DHS, the Employer must promptly
notify employees in private of the finding and provide them with the notice and letter containing
information specific to the employee’s E-Verify case. The Employer also agrees to provide both the
English and the translated notice and letter for employees with limited English proficiency to
employees. The Employer must allow employees to contest the finding, and not take adverse action
against employees if they choose to contest the finding, while their case is still pending.
2. The Employer agrees to obtain the employee’s response about whether he or she will contest the
tentative nonconfirmation as soon as possible after the Employer receives the tentative
nonconfirmation. Only the employee may determine whether he or she will contest the tentative
nonconfirmation.
3. The Employer agrees to refer individuals to DHS only when the employee chooses to contest a
tentative nonconfirmation.
4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer will instruct the
employee to contact DHS through its toll-free hotline (as found on the referral letter) within eight
Federal Government work days.
5. If the Employer finds a photo mismatch, the Employer must provide the photo mismatch tentative
nonconfirmation notice and follow the instructions outlined in paragraph 1 of this section for tentative
nonconfirmations, generally.
6. The Employer agrees that if an employee contests a tentative nonconfirmation based upon a photo
mismatch, the Employer will send a copy of the employee’s Form I-551, Form I-766, U.S. Passport, or
passport card to DHS for review by:
a. Scanning and uploading the document, or
b. Sending a photocopy of the document by express mail (furnished and paid for by the
employer).
7. The Employer understands that if it cannot determine whether there is a photo match/mismatch, the
Employer must forward the employee’s documentation to DHS as described in the preceding
paragraph. The Employer agrees to resolve the case as specified by the DHS representative who will
determine the photo match or mismatch.
8. DHS will electronically transmit the result of the referral to the Employer within 10 Federal
Government work days of the referral unless it determines that more than 10 days is necessary.
9. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case
updates.
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ARTICLE IV
SERVICE PROVISIONS
A. NO SERVICE FEES
1. SSA and DHS will not charge the Employer or the Web Services E-Verify Employer Agent for
verification services performed under this MOU. The Employer is responsible for providing equipment
needed to make inquiries. To access E-Verify, an Employer will need a personal computer with Internet
access.
ARTICLE V
SYSTEM SECURITY AND MAINTENANCE
A. DEVELOPMENT REQUIREMENTS
1. Software developed by Web Services E-Verify Employer Agents must comply with federally-
mandated information security policies and industry security standards to include but not limited to:
a. Public Law 107-347, “E-Government Act of 2002, Title III, Federal Information Security
Management Act (FISMA),December 2002.
b. Office of Management and Budget (OMB) Memorandum (M-10-15), FY 2010 Reporting
Instructions for the Federal Information Security Management Act and Agency Privacy
Management,April 2010.
c. National Institute of Standards and Technology (NIST) Special Publication (SP) and Federal
Information Processing Standards Publication (FIPS).
d. International Organization for Standardization/International Electrotechnical Commission
(ISO/IEC) 27002, Information Technology Security Techniques Code of Practice for
Information Security Management.
2. The Web Services E-Verify Employer Agent agrees to update its Web Services interface to reflect
system enhancements within six months from the date DHS notifies the Web Services User of the
system update. The Web Services User will receive notice from DHS in the form of an Interface Control
Agreement (ICA). The Web Services E-Verify Employer Agent agrees to institute changes to its
interface as identified in the ICA, including all functionality identified and all data elements detailed
therein.
3. The Web Services E-Verify Employer Agent agrees to demonstrate progress of its efforts to update
its Web Services interface if and when DHS requests such progress reports.
4. The Web Services E-Verify Employer Agent acknowledges that if its system enhancements are not
completed to the satisfaction of DHS or its assignees within six months from the date DHS notifies the
Web Services User of the system update, then the Web Services User’s E-Verify account may be
suspended, and support for previous releases of E-Verify may no longer be available to the Web
Services User. The Web Services E-Verify Employer Agent also acknowledges that DHS may suspend
the Web Services User’s account after the six-month period has elapsed.
5. The Web Services E-Verify Employer Agent agrees to incorporate error handling logic into its
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development
or software to accommodate and act in a timely fashion should an error code be returned.
6. The Web Services E-Verify Employer Agent agrees to complete the technical requirements testing
which is confirmed upon receiving approval of test data and connectivity between the Web Services
E-Verify Employer Agent and DHS.
7. DHS will not reimburse any Web Services E-Verify Employer Agent or software developer who has
expended resources in the development or maintenance of a Web Services interface if that party is
unable, or becomes unable, to meet any of the requirements set forth in this MOU.
8. Housing, development, infrastructure, maintenance, and testing of the Web Services applications
may take place outside the United States and its territories, but testing must be conducted to ensure
that the code is correct and secure.
9. If the Web Services E-Verify Employer Agent includes an electronic Form I-9 as part of its interface,
then it must comply with the standards for electronic retention of Form I-9 found in 8 CFR 274a.2(e).
B. INFORMATION SECURITY REQUIREMENTS
Web Services E-Verify Employer Agents performing verification services under this MOU must ensure
that information that is shared between the Web Services E-Verify Employer Agent and DHS is
appropriately protected comparable to the protection provided when the information is within the DHS
environment [OMB Circular A-130 Appendix III].
To achieve this level of information security, the Web Services E-Verify Employer Agent agrees to
institute the following procedures:
1. Conduct periodic assessments of risk, including the magnitude of harm that could result from the
unauthorized access, use, disclosure, disruption, modification, or destruction of information and
information systems that support the operations and assets of the DHS, SSA, and the Web Services
E-Verify Employer Agent and its clients;
2. Develop policies and procedures that are based on risk assessments, cost-effectively reduce
information security risks to an acceptable level, and ensure that information security is addressed
throughout the life cycle of each organizational information system;
3. Implement subordinate plans for providing adequate information security for networks, facilities,
information systems, or groups of information systems, as appropriate;
4. Conduct security awareness training to inform the Web Services E-Verify Employer Agent’s
personnel (including contractors and other users of information systems that support the operations
and assets of the organization) of the information security risks associated with their activities and their
responsibilities in complying with organizational policies and procedures designed to reduce these
risks;
5. Develop periodic testing and evaluation of the effectiveness of information security policies,
procedures, practices, and security controls to be performed with a frequency depending on risk, but no
less than once per year;
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6. Dev
elop a process for planning, implementing, evaluating, and documenting remedial actions to
address any deficiencies in the information security policies, procedures, and practices of the
organization;
7. Implement procedures for detecting, reporting, and responding to security incidents;
8. Create plans and procedures to ensure continuity of operations for information systems that support
the operations and assets of the organization;
9. In information-sharing environments, the information owner is responsible for establishing the rules
for appropriate use and protection of the subject information and retains that responsibility even when
the information is shared with or provided to other organizations [NIST SP 800-37].
10. DHS reserves the right to restrict Web Services calls from certain IP addresses.
11. DHS reserves the right to audit the Web Services E-Verify Employer Agent’s application.
12. Web Services E-Verify Employer Agents and Software Developers agree to cooperate willingly
with the DHS assessment of information security and privacy practices used by the company to
develop and maintain the software.
C. DATA PROTECTION AND PRIVACY REQUIREMENTS
1. Web Services E-Verify Employer Agents must practice proper Internet security; this means using
HTTP over SSL/TLS (also known as HTTPS) when accessing DHS information resources such as
E-Verify [NIST SP 800-95]. Internet security practices like this are necessary because Simple Object
Access Protocol (SOAP), which provides a basic messaging framework on which Web Services can be
built, allows messages to be viewed or modified by attackers as messages traverse the Internet and is
not independently designed with all the necessary security protocols for E-Verify use.
2. In accordance with DHS standards, the Web Services E-Verify Employer Agent agrees to maintain
physical, electronic, and procedural safeguards to appropriately protect the information shared under
this MOU against loss, theft, misuse, unauthorized access, and improper disclosure, copying use,
modification or deletion.
3. Any data transmission requiring encryption shall comply with the following standards:
Products using FIPS 197 Advanced Encryption Standard (AES) algorithms with at least 256-
bit encryption that has been validated under FIPS 140-2.
NSA Type 2 or Type 1 encryption.
4. User ID Management (Set Standard): All information exchanged between the parties under this
MOU will be done only through authorized Web Services E-Verify Employer Agent representatives
identified above.
5. The Web Services E-Verify Employer Agent agrees to use the E-Verify browser instead of its own
interface if it has not yet upgraded its interface to comply with the Federal Acquisition Regulation (FAR)
system changes. In addition, Web Services E-Verify Employer Agents whose interfaces do not support
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the Form I-9
from 2/2/2009 or 8/7/2009 should also use the E-Verify browser until the system upgrade
is completed.
6. The Web Services E-Verify Employer Agent agrees to use the E-Verify browser instead of its own
interface if it has not completed updates to its system within six months from the date DHS notifies the
Web Services E-Verify Employer Agent of the system update. The Web Services E-Verify Employer
Agent can resume use of its interface once it is up-to-date, unless the Web Services E-Verify Employer
Agent has been suspended or terminated from continued use of the system.
D. COMMUNICATIONS
1. Web Services E-Verify Employer Agents and Software Developers agree to develop an electronic
system that is not subject to any agreement that would restrict access to and use of by an agency of
the United States.
2. The Web Services E-Verify Employer Agent agrees to develop effective controls to ensure the
integrity, accuracy and reliability of its electronic system.
3. The Web Services E-Verify Employer Agent agrees to develop an inspection and quality assurance
program that regularly, at least once per year, evaluates the electronic system, and includes periodic
checks of electronically stored information. The Web Services E-Verify Employer Agent agrees to
share the results of its regular inspection and quality assurance program with DHS upon request.
4. The Web Services E-Verify Employer Agent agrees to develop an electronic system with the ability
to produce legible copies of applicable notices, letters, etc.
5. All information exchanged between the parties under this MOU will be in accordance with applicable
laws, regulations, and policies, including but not limited to, information security guidelines of the
sending party with respect to any information that is deemed Personally Identifiable Information (PII),
including but not limited to the employee or applicant’s Social Security number, alien number, date of
birth, or other information that may be used to identify the individual.
6. Suspected and confirmed information security breaches must be reported to DHS according to
Article II.A.17. Reporting such breaches does not relieve the Web Services E-Verify Employer Agent
from further requirements as directed by state and local law. The Web Services E-Verify Employer
Agent is subject to applicable state laws regarding data protection and incident reporting in addition to
the requirements herein.
E. SOFTWARE DEVELOPER RESTRICTIONS
1. The Web Services E-Verify Employer Agent agrees that if it develops a Web Services interface and
sells such interface, then it can be held liable for any misuse by the company that purchases the
interface. It is the responsibility of the Web Services E-Verify Employer Agent to ensure that its
interface is used in accordance with E-Verify policies and procedures.
2. The Web Services E-Verify Employer Agent agrees to provide software updates to each client who
purchases its software. Because of the frequency Web Services updates, an ongoing relationship
between the software developer and the client is necessary.
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3. DH
S reserves the right to terminate the access of any software developer with or without notice who
creates or uses an interface that does not comply with E-Verify procedures.
4. Web Services Software Developers pursuing software development independent of serving clients
as a Web Services E-Verify Employer Agent are not eligible to receive an ICA. At this time, E-Verify
does not permit Web Services software development without also being a Web Services E-Verify
Employer Agent or Web Services Employer.
F. PENALTIES
1. The Web Services E-Verify Employer Agent agrees that any failure on its part to comply with the
terms of the MOU may result in account suspension, termination, or other adverse action.
2. DHS is not liable for any financial losses to Web Services E-Verify Employer Agent, its clients, or
any other party as a result of your account suspension or termination.
ARTICLE VI
MODIFICATION AND TERMINATION
A. MODIFICATION
1. This MOU is effective upon the signature of all parties and shall continue in effect for as long as the
SSA and DHS operates the E-Verify program unless modified in writing by the mutual consent of all
parties.
2. Any and all E-Verify system enhancements by DHS or SSA, including but not limited to E-Verify
checking against additional data sources and instituting new verification policies or procedures, will be
covered under this MOU and will not cause the need for a supplemental MOU that outlines these
changes.
B. TERMINATION
1. The Web Services E-Verify Employer Agent may terminate this MOU and its participation in E-Verify
at any time upon 30 days prior written notice to the other parties. In addition, any Employer
represented by the Web Services E-Verify Employer Agent may voluntarily terminate its MOU upon
giving DHS 30 days’ written notice. The Web Services E-Verify Employer Agent may not refuse to
terminate the Employer based upon an outstanding bill for verification services.
2. Notwithstanding Article V, part A of this MOU, DHS may terminate this MOU, and thereby the Web
Services E-Verify Employer Agent’s participation in E-Verify, with or without notice at any time if
deemed necessary because of the requirements of law or policy, or upon a determination by SSA or
DHS that there has been a breach of system integrity or security by the Web Services E-Verify
Employer Agent or Employer, or a failure on the part of either party to comply with established E-Verify
procedures and/or legal requirements. The Employer understands that if it is a Federal contractor,
termination of this MOU by any party for any reason may negatively affect the performance of its
contractual responsibilities. Similarly, the Employer understands that if it is in a state where E-Verify is
mandatory, termination of this by any party MOU may negatively affect the Employer’s business.
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3. A Web
Services E-Verify Employer Agent for an Employer that is a Federal contractor may
terminate this MOU when the Federal contract that requires its participation in E-Verify is terminated or
completed. In such cases, the Web Services E-Verify Employer Agent must provide written notice to
DHS. If the Web Services E-Verify Employer Agent fails to provide such notice, then that Employer will
remain an E-Verify participant, will remain bound by the terms of this MOU that apply to non-Federal
contractor participants, and will be required to use the E-Verify procedures to verify the employment
eligibility of all newly hired employees.
4. The Web Services E-Verify Employer Agent agrees that E-Verify is not liable for any losses,
financial or otherwise, if the Web Services E-Verify Employer Agent or the Employer is terminated from
E-Verify.
ARTICLE VII
PARTIES
A. Some or all SSA and DHS responsibilities under this MOU may be performed by contractor(s), and
SSA and DHS may adjust verification responsibilities between each other as necessary. By separate
agreement with DHS, SSA has agreed to perform its responsibilities as described in this MOU.
B. Nothing in this MOU is intended, or should be construed, to create any right or benefit, substantive
or procedural, enforceable at law by any third party against the United States, its agencies, officers, or
employees, or against the Web Services E-Verify Employer Agent, its agents, officers, or employees.
C. The Web Services E-Verify Employer Agent may not assign, directly or indirectly, whether by
operation of law, change of control or merger, all or any part of its rights or obligations under this MOU
without the prior written consent of DHS, which consent shall not be unreasonably withheld or delayed.
Any attempt to sublicense, assign, or transfer any of the rights, duties, or obligations herein is void.
D. Each party shall be solely responsible for defending any claim or action against it arising out of or
related to E-Verify or this MOU, whether civil or criminal, and for any liability wherefrom, including (but
not limited to) any dispute between the Web Services E-Verify Employer Agent or the Employer and
any other person or entity regarding the applicability of Section 403(d) of IIRIRA to any action taken or
allegedly taken by the Web Services E-Verify Employer Agent or the Employer.
E. The Web Services E-Verify Employer Agent understands that its participation in E-Verify is not
confidential information and may be disclosed as authorized or required by law and DHS or SSA policy,
including but not limited to, Congressional oversight, E-Verify publicity and media inquiries,
determinations of compliance with Federal contractual requirements, and responses to inquiries under
the Freedom of Information Act (FOIA).
F. The individuals whose signatures appear below represent that they are authorized to enter into this
MOU on behalf of the Employer, the Web Services E-Verify Employer Agent and DHS respectively.
The Web Services E-Verify Employer Agent understands that any inaccurate statement,
representation, data or other information provided to DHS may subject the Web Services E-Verify
Employer Agent, as the case may be, its subcontractors, its employees, or its representatives to: (1)
prosecution for false statements pursuant to 18 U.S.C. 1001 and/or; (2) immediate termination of its
MOU and/or; (3) possible debarment or suspension.
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G. The foregoing constitutes the full agreement on this subject between DHS, the Employer, and the
E-Verify Employer Agent. <employer_name> (Employer) hereby designates and appoints
<agent_name> (E-Verify Employer Agent) including its officers and employees, as the E-Verify Employer
Agent for the purpose of carrying out (Employer) responsibilities under the MOU between the Employer,
the E-Verify Employer Agent, and DHS.
If you have any questions, contact E-Verify at 1-888-464-4218.
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Approved by:
Employer
Name (Please Type or Print) Title
Signature Date
E-Verify Employer Agent
Name (Please Type or Print) Title
Signature Date
Department of Homeland Security Verification Div
ision
Name (Please Type or Print) Title
Signature Date
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Company ID Number:
Client Company ID Number:
Information Required for the E-Verify Program
Information relating to your Company:
Company Name
Company Facility Address
Company Alternate Address
County or Parish
Employer Identification Number
North American Industry
Classification
Systems Code
Parent Company
Number of Employees
Number of Sites Verified for
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Company ID Number:
Client Company ID Number:
Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in
each State:
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Company ID Number:
Client Company ID Number:
Information relating to the Program Administrator(s) for your Company on policy questions or
operational problems:
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Company ID Number:
Client Company ID Number:
This list represents the first 20 Program Administrators listed for this company.