Sign Up Form | Social Service Verification Enrollment

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Government Sign Up Intro
Gov't Sign Up - Step 1

looking to sign up for government benefits?

Please visit your state government website.

Please note the sign up form below is intended for government agencies who are requesting employment and income verifications for a fee. This is not a channel for individuals to apply for government benefits.

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ENTER YOUR AGENCY INFORMATION

Fill in details about your agency here.

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ENTER YOUR AGENCY INFORMATION

Fill in details about your agency here.

I acknowledge this service is a fee-based service.*

Legal Agency Name *

Other Business Name(s)

Phone Number *

Street Address *

Address Line 2 (apartment, unit, building, floor, etc.)

City *

State *

Zip Code *

Will verifications be stored at the legal address? *

YES

Where will verifications be stored? *

Alternate Street Address *

Alternate Address Line 2 (apartment, unit, building, floor, etc.)

City *

State *

Zip Code *

Yearly Expected Usage *

Less than 2000

Between 2000 and 6000

More than 6000

Next: Agency type

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SELECT YOUR AGENCY TYPE(S)

Check all the options that apply to your agency from the list below.

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SELECT YOUR AGENCY TYPE(S)

Check all the options that apply to your agency from the list below.

Apartment Complex / Property Management

Number of Affordable / Subsidized Units *

Education / Accreditation

Federal / State / County / City / Local Government

Housing Authority

Number of Units *

Medical / Healthcare

Non-Profit Organization

Third Party Vendor for Government Agency

Other

Please Specify: *

< BACK TO STEP 1

Next: Agency Programs

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SELECT YOUR AGENCY PROGRAM(S)

Select all the programs/divisions that will use this service below.

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SELECT YOUR AGENCY PROGRAM(S)

Select all the programs/divisions that will use this service below.

Accreditation

Affordable / Low Income / Tax Credit Housing

Child Support Enforcement

Collections

Day Care Assistance

Fraud Investigations

Low-income Energy Assistance

Medicaid

Medicare

Mortgage Loans

Pre-Employment Screening For Your Agency's Hiring Process

SNAP / TANF

Social Security Administration

Work-related Assistance

Unemployment Insurance

None of the Above Apply

Please Specify: *

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Next: Contact Information

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ENTER YOUR CONTACT INFORMATION

Share your contact information here.

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ENTER YOUR CONTACT INFORMATION

Share your contact information here.

Main Contact Full Legal Name *

Main Contact Phone Number *

Main Contact Email Address *

Is the main contact the contract signer? *

Yes

Full Name of contract signer *

Email to Send Contract to *

< BACK TO STEP 3