Legal SSN Notice

LEGAL SSN NOTICE

This Legal SSN Notice (the "Notice") is entered into by and between Requesting Party: and Individual Name: , effective as of .

RECITALS

WHEREAS, the Requesting Party requires the Individual's social security number for identification, tax reporting, benefits administration, background verification, or other lawful business purposes as set forth in this Notice;

WHEREAS, federal and state law permit or require collection and use of the social security number in certain transactions and require that the Individual be notified of the reasons for collection, the authority for the collection, and the uses and disclosures permitted by law;

WHEREAS, the parties desire to document the Individual's provision of the social security number and the Requesting Party's commitments regarding use, disclosure, retention, security, access, and correction;

NOW, THEREFORE, in consideration of the mutual covenants set forth herein, the parties agree as follows:

1. Collection and Purpose

1.1 The Individual hereby provides the following social security number to the Requesting Party for the specific purposes of: tax reporting, wage and benefit administration, identity verification, background screening, and compliance with statutory or regulatory obligations. The social security number collected will be used only as reasonably necessary to carry out these lawful purposes.

1.2 The Individual acknowledges that provision of the social security number is required where necessary for the Requesting Party to discharge legal or contractual obligations and that failure to provide the social security number may prevent the Requesting Party from completing employment, payment, benefit or reporting activities.

2. Social Security Number

3. Use and Disclosure

3.1 The Requesting Party shall use the social security number only for the purposes described in Section 1 and for ancillary administrative uses reasonably related thereto. Permitted disclosures include disclosure to payroll processors, benefits administrators, tax authorities, auditors, government agencies when required by law, and third-party service providers under contract who are bound by confidentiality obligations.

3.2 Any disclosure of the social security number for purposes not described in this Notice shall require prior written consent of the Individual unless otherwise required by law.

4. Retention and Security

4.1 The Requesting Party shall retain records containing the social security number only for as long as necessary to satisfy the purposes described in Section 1 or as otherwise required by applicable law. When records containing the social security number are no longer required, the Requesting Party shall destroy or render unreadable those records in a manner consistent with reasonable administrative, technical, and physical safeguards.

4.2 The Requesting Party shall implement administrative, technical, and physical safeguards appropriate to the sensitivity of the social security number to protect against unauthorized access, disclosure, or misuse.

5. Access, Correction, and Complaint

5.1 The Individual has the right to request access to records containing the social security number and to request correction of any inaccuracies. Such requests shall be submitted in writing to the Notice Recipient identified in Section 7.

5.2 The Requesting Party shall respond to reasonable requests to access or correct social security number records within a reasonable time and in accordance with applicable law.

6. Individual Authorization and Certification

By signing below, the Individual authorizes the Requesting Party to collect, use, retain, and disclose the social security number as described in this Notice. The Individual certifies, under penalty of perjury to the extent permitted by law, that the social security number provided is the Individual's correct and lawful social security number.

I consent to the collection and use of my social security number as described in this Notice.

7. Notices

All formal notices under this Notice shall be in writing and delivered to the Notice Recipient designated by the Requesting Party or to the Individual at the addresses provided below. Notice shall be effective upon delivery.

8. Consequences of Refusal

If the Individual refuses to provide the social security number where provision is required to satisfy statutory or contractual obligations, the Requesting Party may be unable to process payroll, tax reporting, benefits enrollment, or other transactions and may take actions permitted by law or contract, including withholding, termination of transaction, or denial of enrollment in programs that require the social security number.

9. Governing Law; Miscellaneous Provisions

9.1 Governing Law. This Notice shall be governed by and construed in accordance with the substantive laws of the state governing the Requesting Party's principal place of business, without regard to conflict of law principles.

9.2 Entire Agreement. This Notice constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior understandings and agreements, whether written or oral, relating to the collection, use, retention, and disclosure of the social security number.

9.3 Severability. If any provision of this Notice is held to be invalid or unenforceable, that provision shall be severed and the remainder of this Notice shall remain in full force and effect.

9.4 Amendments; Waiver. This Notice may be amended only by a written instrument signed by both parties. Failure to enforce any provision shall not constitute a waiver of future enforcement of that or any other provision.

9.5 Counterparts. This Notice may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

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