Social Security No. Disclosure

We are required to obtain Social Security numbers in connection with your application for occupational and professional licenses to comply with federal law as set out in 42 U.S.C. §§ 450(c)(2)(C)(i), 654, and 666, and by state law under Ark. Code Ann. § 17-1-104. Your Social Security number may then be used for the purposes set forth in those statutes, including the enforcement of spousal and child support orders and paternity determinations, and the administration of tax systems, and may be shared with the agencies which have responsibility for those matters. Your Social Security number will not appear on the face of your license, but will be kept on file by the Arkansas Insurance Department with your license information.

In addition, you may on a voluntary basis permit the Arkansas Insurance Department to use your Social Security number for internal identification purposes and to share your Social Security number with the National Association of Insurance Commissioners (NAIC) for inclusion in the national producer databases (PDB) as a means of identification. The PDB is intended to assist in a uniform nationwide system of licensing through that allows the NAIC to provide licensing information to state insurance regulators and the National Insurance Producer Registry (NIPR)to provide licensing information to insurance companies for compliance purposes. Your Social Security number will not be displayed to state insurance regulators or NIPR customers on these national producer databases. If you do not wish the Arkansas Insurance Department to share your Social Security number with the NAIC or NIPR you will not be able to take advantage of electronic processing of your license and nationwide licensing using the these national producer databases.

IF YOU DO NOT AGREE TO THE USE OF YOUR SOCIAL SECURITY NUMBER AS DESCRIBED IN PARAGRAPH 2, YOU MUST SO ADVISE THE DEPARTMENT IN WRITING TO THE ADDRESS BELOW.