Authorizing Signatures and Dates. The signatories below warrant and represent that they have the competent authority on behalf of their respective agencies or companies to enter into the obligations set forth in this User Agreement.
Authorizing Signatures and Dates. The signatories below warrant and represent that they have the competent authority on behalf of their respective entities to enter into the obligations set forth in this Reimbursable Agreement. For SSA: _________________________________ Date __________ (Signature) Printed name: ________________________________ Title: _______________________________________ Social Security Administration
Authorizing Signatures and Dates. The signatories below warrant and represent that they have the competent authority on behalf of their respective entities to enter into the obligations set forth in this Reimbursable Agreement. For SSA:
Authorizing Signatures and Dates. Each signatory below warrants and represents that he/she has the competent authority on behalf of his/her respective agency to enter into the obligations and agree to the terms set forth in this Memorandum of Understanding between FHFA and HUD regarding Fair Lending Coordination. For the U.S. Department of Housing and Urban Development �Xxxxxx X. Xxx/�cJ-�� Secretary Department of Housing and Urban Development For the Federal Housing Finance Agency /'--/,2-�-4 Date 8/ 1:2-/.2.0.;;X X Xxxxxx . Xxxxxxxx D�e Acting Director Federal Housing Finance Agency
Authorizing Signatures and Dates. The signatories below warrant and represent that they have the competent authority on behalf of their respective entities to enter into the obligations set forth in this User Agreement. For Social Security Administration: Date (Signature) Printed Name: Xxxxxxx Xxxxxxxxxxx Associate Commissioner, Office of Data Exchange & Policy Publications For Requesting Party: Date (Signature) Printed Name: Title: Company Name: Attachment A – Form SSA-88 SAMPLE Attachment B - Form SSA 89 SAMPLE Page 25 of 46 User Agreement Between SSA and Requesting Party for CBSV Effective 10/1/16 Attachment C - Form SSA 89-S Administración del Seguro Social Autorización para que la Administración de Seguro Social Divulgue la Verificación de un Número de Seguro Social (SSN) Nombre en letra de molde Fecha de nacimiento Número de Seguro Social Quiero que esta información sea divulgada porque estoy llevando a cabo la siguiente transacción de negocios Razones para solicitar el CBSV: (Favor de marcar todo lo que aplique a esta divulgación) Empresa hipotecária Investigación de antecedentes Investigación crediticia con la siguiente empresa (“la Empresa”): Servicios bancarios Requisito para obtener una licencia Otra razón (explique) Nombre de la Empresa Dirección SAMPLE Yo autorizo a la Administración del Seguro Social a que verifique mi nombre y número de Seguro Social (SSN, sus siglas en inglés) a la Empresa o al agente de la Empresa, si procede, para el propósito que he identificado. El nombre y la dirección del agente de la Empresa es: Yo soy la persona a quien el número de Seguro Social fue emitió o el representante legal de un menor o el representante legal de una persona quien ha sido declarado por la corte un adulto incompetente. Yo declaro y afirmo bajo xxxx de perjurio que la información contenida aquí es verdadera y correcta. Yo reconozco que si hago alguna representación, que yo sé que es falsa, para obtener información de los registros del Seguro Social, puedo ser declarado culpable de un delito menor y penalizado con una multa de hasta $5,000. Este consentimiento xx xxxxxx por solo 90 xxxx de la fecha en que es firmado, a menos que se indique lo contrario por la persona nombrada en el encabezamiento. Si quiere cambiar este límite de tiempo, xxxxx los siguientes blancos: Este consentimiento xx xxxxxx por xxxx de la fecha en que es firmado. (Sus iniciales, por favor.) Firma Fecha en que firmó Parentesco (si no es la persona a quien le pertenece el SSN): Información de contacto de l...
Authorizing Signatures and Dates. The signatories below warrant and represent that they have the competent authority on behalf of their respective agencies or companies to enter into the obligations set forth in this User Agreement. Requesting Party (Signature) SSA Representative (Signature) Printed Name: Title: Company Name: Printed Name: Xxxxxxx Xxxxxxxxxxx Title: Associate Commissioner
Authorizing Signatures and Dates. SWhen M.ooNCConttngr fin ficer Division of Contracts and Property Management Nuclear Regulatory Commission Date "Xxxxx X. k ey, Jr. Director of perations Program Support Center Dt Date FILENAME = C:\hhsiaa.wpd
Authorizing Signatures and Dates. Each signatory below warrants and represents that he/she has the competent authority on behalf of his/her respective agency to enter into the obligations and agree to the terms set forth in this Memorandum of Understanding between FHFA and HUD regarding Fair Lending Coordination.
Authorizing Signatures and Dates. The signatories below warrant and represent that they have the competent authority on behalf of their respective agencies or companies to enter into the obligations set forth in this Agreement. The signatories may sign this document electronically by using an approved electronic signature process. Each signatory electronically signing this document agrees that his/her electronic signature has the same legal validity and effect as his/her handwritten signature on the document, and that it has the same meaning as his/her handwritten signature. SOCIAL SECURITY ADMINISTRATION PERMITTED ENTITY Xxxxx Train Name Associate Commissioner Title Data Exchange, Policy Publications, and Permitted Entity’s Name International Negotiations Date: Date:
Authorizing Signatures and Dates. APPROVED AND ACCEPTED BY APPROVED AND ACCEPTED BY DIA Site Date Name & Title Date DIA Schedule 1 List of Providers Instructions to Site (OS): If this is the first Schedule 1, the listed Providers may begin performing Contracted Services for Facility Name (OS) once OS has signed, dated and returned this Schedule 1 to DIA (DS) via fax to the fax number listed below. If this is a revised Schedule 1 ("Revised Schedule 1"), the parties will identify any added Provider(s) by placing an "A" next to their name(s), and will identify any removed Provider(s) by placing an "R" next to their name(s). Any added Provider(s) may begin providing contracted Services once DIA (DS) receives an executed, dated copy of the Revised Schedule 1 via fax from Facility Name (OS). Previously listed Providers will remain on the Schedule 1 unless and until they are removed. When complete, please sign and fax back both pages to DIA (DS) [000-000-0000]. DIA (DS) has issued privileges to the following Providers and requests confirmation from Site (OS) that each Provider has been issued Site (OS) privileges or is otherwise permitted to provide Contracted Services to Site (OS). Previously listed Providers will remain on the Schedule 1 unless and until they are removed.
