Form SS-5 "Application for a Social Security Card"

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  1. What Is Form SS-5?
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  3. Download Form SS-5 PDF
  4. Form SS-5 Instructions
  5. Where to Mail Social Security Card Application?

What Is Form SS-5?

Form SS-5, Application for Social Security Card, is a legal document filled out to apply for a new or replacement Social Security card. This card is necessary for any individual who wants to find employment, go to the doctor, open a bank account, and receive various benefits. Whether your parents or legal guardians did not obtain a Social Security card for you or it was lost or mutilated, you may submit an application to get a new card. You should fill out Form SS-5 in the following circumstances:

  1. You need to obtain an original Social Security card.
  2. You have to replace your Social Security card.
  3. You want to correct or change the information in your Social Security records - for instance, you have changed your name after a marriage or divorce.

Alternate Name:

  • Social Security Card Application

This form was released by the Social Security Administration (SSA). The latest version of the form was issued on November 1, 2019, with all previous editions obsolete. You can download a fillable SS-5 Application through the link below.

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Form SS-5 Instructions

Provide these details in the Form SS-5:

  1. State your full name. If your name at birth was different or you have ever used other names, indicate them in the provided space.
  2. If you were previously assigned a Social Security number, write it down.
  3. Add your place and date of birth.
  4. Check one box to specify your citizenship status - a citizen, legal alien allowed or not allowed to work, and other. Attach a document from a government agency that clarifies your need for a Social Security number and shows you comply with all the requirements for the government benefit.
  5. Indicate your ethnicity and race (the response is voluntary).
  6. Check the box to specify your sex.
  7. Provide information about your parents - their full names and social security numbers if known.
  8. If you have ever filed for or received a Social Security card before, answer "yes" and state your name and date of birth used on an earlier application or card.
  9. Date the form, enter your phone number and mailing address. Sign the form. If the form is completed by an individual different from the one identified in the application, check the box to explain your relationship to this person - you are their parent, legal guardian, or authorized representative.

The SSA requires evidence documents to confirm statements made in the application. These supporting documents are the most common - attach originals or their certified copies:

  • Evidence of identity. Submit a driver's license, non-driver identity card, or U.S. passport. As an alternative, attach a U.S. military identity card, medical or school records. They will demonstrate your legal name and furnish biographical details;
  • Evidence of age. Usually, a birth certificate is submitted, but the SSA will also accept hospital and religious records of your birth, adoption decree, or passport;
  • Evidence of citizenship. It is generally confirmed by the birth certificate or passport issued in the U.S.;
  • Evidence of immigration status. The Department of Homeland Security must provide you with a document that shows your immigration status.

Where to Mail Social Security Card Application?

You may submit or send the signed application to the SSA office or Social Security Card Center of your choice - most people choose the nearest office that serves their area. It is recommended to fill out SS-5 Form and bring it to an office. Since you have to attach various supporting documentation to prove your identity, age, citizenship, and immigration status when mailing the application, it is best to simply present all these documents in the office and get them back immediately.

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Form SS-5 (11-2019) UF
Page 1 of 5
Discontinue Prior Editions
SOCIAL SECURITY ADMINISTRATION
OMB No. 0960-0066
Application for a Social Security Card
free!
Applying for a Social Security Card is
USE THIS APPLICATION TO:
●
Apply for an original Social Security card
●
Apply for a replacement Social Security card
●
Change or correct information on your Social Security number record
IMPORTANT: You MUST provide a properly completed application and the required evidence before we can process
your application. We can only accept original documents or documents certified by the custodian of the original record.
Notarized copies or photocopies which have not been certified by the custodian of the record are not acceptable. We
will return any documents submitted with your application. For assistance call us at 1-800-772-1213 or visit our
website at www.socialsecurity.gov.
Original Social Security Card
To apply for an original card, you must provide at least two documents to prove age, identity, and U.S. citizenship or
current lawful, work-authorized immigration status. If you are not a U.S. citizen and do not have DHS work
authorization, you must prove that you have a valid non-work reason for requesting a card. See page 2 for an
explanation of acceptable documents.
NOTE: If you are age 12 or older and have never received a Social Security number, you must apply in person.
Replacement Social Security Card
To apply for a replacement card, you must provide one document to prove your identity. If you were born outside the
U.S., you must also provide documents to prove your U.S. citizenship or current, lawful, work-authorized status. See
page 2 for an explanation of acceptable documents.
Changing Information on Your Social Security Record
To change the information on your Social Security number record (i.e., a name or citizenship change, or corrected
date of birth) you must provide documents to prove your identity, support the requested change, and establish the
reason for the change. For example, you may provide a birth certificate to show your correct date of birth. A document
supporting a name change must be recent and identify you by both your old and new names. If the name change
event occurred over two years ago or if the name change document does not have enough information to prove your
identity, you must also provide documents to prove your identity in your prior name and/or in some cases your new
legal name. If you were born outside the U.S. you must provide a document to prove your U.S. citizenship or current
lawful, work-authorized status. See page 2 for an explanation of acceptable documents.
LIMITS ON REPLACEMENT SOCIAL SECURITY CARDS
Public Law 108-458 limits the number of replacement Social Security cards you may receive to 3 per calendar year
and 10 in a lifetime. Cards issued to reflect changes to your legal name or changes to a work authorization legend do
not count toward these limits. We may also grant exceptions to these limits if you provide evidence from an official
source to establish that a Social Security card is required.
IF YOU HAVE ANY QUESTIONS
If you have any questions about this form or about the evidence documents you must provide, please visit our website
at
www.socialsecurity.gov
for additional information as well as locations of our offices and Social Security Card
Centers. You may also call Social Security at 1-800-772-1213. You can also find your nearest office or Card Center in
your local phone book.
Form SS-5 (11-2019) UF
Page 1 of 5
Discontinue Prior Editions
SOCIAL SECURITY ADMINISTRATION
OMB No. 0960-0066
Application for a Social Security Card
free!
Applying for a Social Security Card is
USE THIS APPLICATION TO:
●
Apply for an original Social Security card
●
Apply for a replacement Social Security card
●
Change or correct information on your Social Security number record
IMPORTANT: You MUST provide a properly completed application and the required evidence before we can process
your application. We can only accept original documents or documents certified by the custodian of the original record.
Notarized copies or photocopies which have not been certified by the custodian of the record are not acceptable. We
will return any documents submitted with your application. For assistance call us at 1-800-772-1213 or visit our
website at www.socialsecurity.gov.
Original Social Security Card
To apply for an original card, you must provide at least two documents to prove age, identity, and U.S. citizenship or
current lawful, work-authorized immigration status. If you are not a U.S. citizen and do not have DHS work
authorization, you must prove that you have a valid non-work reason for requesting a card. See page 2 for an
explanation of acceptable documents.
NOTE: If you are age 12 or older and have never received a Social Security number, you must apply in person.
Replacement Social Security Card
To apply for a replacement card, you must provide one document to prove your identity. If you were born outside the
U.S., you must also provide documents to prove your U.S. citizenship or current, lawful, work-authorized status. See
page 2 for an explanation of acceptable documents.
Changing Information on Your Social Security Record
To change the information on your Social Security number record (i.e., a name or citizenship change, or corrected
date of birth) you must provide documents to prove your identity, support the requested change, and establish the
reason for the change. For example, you may provide a birth certificate to show your correct date of birth. A document
supporting a name change must be recent and identify you by both your old and new names. If the name change
event occurred over two years ago or if the name change document does not have enough information to prove your
identity, you must also provide documents to prove your identity in your prior name and/or in some cases your new
legal name. If you were born outside the U.S. you must provide a document to prove your U.S. citizenship or current
lawful, work-authorized status. See page 2 for an explanation of acceptable documents.
LIMITS ON REPLACEMENT SOCIAL SECURITY CARDS
Public Law 108-458 limits the number of replacement Social Security cards you may receive to 3 per calendar year
and 10 in a lifetime. Cards issued to reflect changes to your legal name or changes to a work authorization legend do
not count toward these limits. We may also grant exceptions to these limits if you provide evidence from an official
source to establish that a Social Security card is required.
IF YOU HAVE ANY QUESTIONS
If you have any questions about this form or about the evidence documents you must provide, please visit our website
at
www.socialsecurity.gov
for additional information as well as locations of our offices and Social Security Card
Centers. You may also call Social Security at 1-800-772-1213. You can also find your nearest office or Card Center in
your local phone book.
Form SS-5 (11-2019) UF
Page 2 of 5
EVIDENCE DOCUMENTS
The following lists are examples of the types of documents you must provide with your application and are not all
inclusive. Call us at 1-800-772-1213 if you cannot provide these documents.
IMPORTANT : If you are completing this application on behalf of someone else, you must provide evidence that
shows your authority to sign the application as well as documents to prove your identity and the identity of the person
for whom you are filing the application. We can only accept original documents or documents certified by the
custodian of the original record. Notarized copies or photocopies which have not been certified by the custodian of the
record are not acceptable.
Evidence of Age
In general, you must provide your birth certificate. In some situations, we may accept another document that shows
your age. Some of the other documents we may accept are:
●
U.S. hospital record of your birth (created at the time of birth)
●
Religious record established before age five showing your age or date of birth
●
Passport
●
Final Adoption Decree (the adoption decree must show that the birth information was taken from the original
birth certificate)
Evidence of Identity
You must provide current, unexpired evidence of identity in your legal name. Your legal name will be shown on the
Social Security card. Generally, we prefer to see documents issued in the U.S. Documents you submit to establish
identity must show your legal name AND provide biographical information (your date of birth, age, or parents' names)
and/or physical information (photograph, or physical description - height, eye and hair color, etc.). If you send a photo
identity document but do not appear in person, the document must show your biographical information (e.g., your date
of birth, age, or parents' names). Generally, documents without an expiration date should have been issued within the
past two years for adults and within the past four years for children.
As proof of your identity, you must provide a:
●
U.S. driver's license; or
●
U.S. State-issued non-driver identity card; or
●
U.S. passport
If you do not have one of the documents above or cannot get a replacement within 10 work days, we may accept
other documents that show your legal name and biographical information, such as a U.S. military identity card,
Certificate of Naturalization, employee identity card, certified copy of medical record (clinic, doctor or hospital), health
insurance card, Medicaid card, or school identity card/record. For young children, we may accept medical records
(clinic, doctor, or hospital) maintained by the medical provider. We may also accept a final adoption decree, or a
school identity card, or other school record maintained by the school.
If you are not a U.S. citizen, we must see your current U.S. immigration document(s) and your foreign passport with
biographical information or photograph.
WE CANNOT ACCEPT A BIRTH CERTIFICATE, HOSPITAL SOUVENIR BIRTH CERTIFICATE, SOCIAL SECURITY
CARD STUB OR A SOCIAL SECURITY RECORD as evidence of identity.
Evidence of U.S. Citizenship
In general, you must provide your U.S. birth certificate or U.S. Passport. Other documents you may provide are a
Consular Report of Birth, Certificate of Citizenship, or Certificate of Naturalization.
Evidence of Immigration Status
You must provide a current unexpired document issued to you by the Department of Homeland Security (DHS)
showing your immigration status, such as Form I-551, I-94, or I-766. If you are an international student or exchange
visitor, you may need to provide additional documents, such as Form I-20, DS-2019, or a letter authorizing
employment from your school and employer (F-1) or sponsor (J-1). We CANNOT accept a receipt showing you
applied for the document. If you are not authorized to work in the U.S., we can issue you a Social Security card only if
you need the number for a valid non-work reason. Your card will be marked to show you cannot work and if you do
work, we will notify DHS. See page 3, item 5 for more information.
Form SS-5 (11-2019) UF
Page 3 of 5
HOW TO COMPLETE THIS APPLICATION
Complete and sign this application LEGIBLY using ONLY black or blue ink on the attached or downloaded
form using only 8 ½” x 11” (or A4 8.25” x 11.7”) paper.
GENERAL: Items on the form are self-explanatory or are discussed below. The numbers match the numbered items
on the form. If you are completing this form for someone else, please complete the items as they apply to that person.
4.
Show the month, day, and full (4 digit) year of birth; for example, “1998” for year of birth.
5.
If you check “Legal Alien Not Allowed to Work” or “Other,” you must provide a document from a U.S.
Federal, State, or local government agency that explains why you need a Social Security number and
that you meet all the requirements for the government benefit. NOTE: Most agencies do not require that
you have a Social Security number. Contact us to see if your reason qualifies for a
Social Security number.
6., 7. Providing race and ethnicity information is voluntary and is requested for informational and statistical
purposes only. Your choice whether to answer or not does not affect decisions we make on your
application. If you do provide this information, we will treat it very carefully.
9.B., 10.B. If you are applying for an original Social Security card for a child under age 18, you MUST show
the parents' Social Security numbers unless the parent was never assigned a Social Security
number. If the number is not known and you cannot obtain it, check the “unknown” box.
13. If the date of birth you show in item 4 is different from the date of birth currently shown on your Social
Security record, show the date of birth currently shown on your record in item 13 and provide evidence
to support the date of birth shown in item 4.
16. Show an address where you can receive your card 7 to 14 days from now.
17. WHO CAN SIGN THE APPLICATION? If you are age 18 or older and are physically and mentally
capable of reading and completing the application, you must sign in item 17. If you are under age 18,
you may either sign yourself, or a parent or legal guardian may sign for you. If you are over age 18 and
cannot sign on your own behalf, a legal guardian, parent, or close relative may generally sign for you. If
you cannot sign your name, you should sign with an "X” mark and have two people sign as witnesses in
the space beside the mark. Please do not alter your signature by including additional information on the
signature line as this may invalidate your application. Call us if you have questions about who may sign
your application.
HOW TO SUBMIT THIS APPLICATION
In most cases, you can take or mail this signed application with your documents to any Social Security office. Any
documents you mail to us will be returned to you. Go to
https://secure.ssa.gov/apps6z/FOLO/fo001.jsp
to find the
Social Security office or Social Security Card Center that serves your area.
Form SS-5 (11-2019) UF
Page 4 of 5
PROTECT YOUR SOCIAL SECURITY NUMBER AND CARD
Protect your SSN card and number from loss and identity theft. DO NOT carry your SSN card with you. Keep it in a
secure location and only take it with you when you must show the card; e.g., to obtain a new job, open a new bank
account, or to obtain benefits from certain U.S. agencies. Use caution in giving out your Social Security number to
others, particularly during phone, mail, email and Internet requests you did not initiate.
PRIVACY ACT STATEMENT
Collection and Use of Personal Information
Sections 205(c) and 702 of the Social Security Act, as amended, allow us to collect this information. Furnishing us this
information is voluntary. However, failing to provide all or part of the information may prevent us from assigning you a
Social Security number (SSN) and issuing you a new or replacement Social Security card.
We will use the information to assign you an SSN and issue you a new or replacement Social Security card. We may
also share your information for the following purposes, called routine uses:
• To Federal, State, and local entities to assist them with administering income maintenance
and health maintenance programs, when a Federal statute authorizes them to use the
SSN; and,
• To the Department of State for administering the Social Security Act in foreign countries
through its facilities and services.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example,
where authorized, we may use and disclose this information in computer matching programs, in which our records are
compared with other records to establish or verify a person's eligibility for Federal benefit programs and for repayment
of incorrect or delinquent debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0058, entitled
Master Files of Social Security Number (SSN) Holders and SSN Applications, as published in the Federal Register
(FR) on December 29, 2010, at 75 FR 82121. Additional information, and a full listing of all of our SORNs, is available
on our website at www.ssa.gov/privacy.
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as
amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless
we display a valid Office of Management and Budget control number. We estimate that it will take about 8.5 to 9.5
minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED
FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through
SSA's website at www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in your
telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send
comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only
comments relating to our time estimate to this address, not the completed form.
Form SS-5 (11-2019) UF
Page 5 of 5
Discontinue Prior Editions
OMB No. 0960-0066
SOCIAL SECURITY ADMINISTRATION
Application for a Social Security Card
First
Full Middle Name
Last
NAME
TO BE SHOWN ON CARD
1
First
Full Middle Name
Last
FULL NAME AT BIRTH
IF OTHER THAN ABOVE
OTHER NAMES USED
Social Security number previously assigned to the person
2
listed in item 1
PLACE OF
DATE
Office
3
4
BIRTH
Use Only
OF
BIRTH
(Do Not Abbreviate)
City
State or Foreign Country
FCI
MM/DD/YYYY
Legal Alien
Legal Alien Not Allowed To
Other (See
CITIZENSHIP
5
U.S. Citizen
Allowed To
Work(See Instructions On
Instructions On
(Check One)
Page 3)
Page 3)
Work
ETHNICITY
RACE
Other Pacific
American Indian
Native Hawaiian
Islander
6
Are You Hispanic or Latino?
7
Select One or More
Alaska Native
Black/African
White
(Your Response is Voluntary)
(Your Response
American
Asian
Yes
No
is Voluntary)
8
SEX
Male
Female
First
Full Middle Name
Last
A. PARENT/ MOTHER'S
NAME AT HER BIRTH
9
B. PARENT/ MOTHER'S SOCIAL SECURITY
Unknown
NUMBER
(See instructions for 9B on Page 3)
First
Full Middle Name
Last
A. PARENT/ FATHER'S
NAME
10
B. PARENT/ FATHER'S SOCIAL SECURITY
Unknown
NUMBER
(See instructions for 10B on Page 3)
Has the person listed in item 1 or anyone acting on his/her behalf ever filed for or received a Social Security number card
11
before?
Don't Know (If "don't know," skip to question 14.)
Yes (If "yes" answer questions 12-13)
No
First
Full Middle Name
Last
Name shown on the most recent Social
12
Security card issued for the person
listed in item 1
Enter any different date of birth if used on an
13
earlier application for a card
MM/DD/YYYY
TODAY'S
DAYTIME PHONE
14
15
DATE
NUMBER
MM/DD/YYYY
Area Code
Number
Street Address, Apt. No., PO Box, Rural Route No.
MAILING ADDRESS
16
City
State/Foreign Country
ZIP Code
(Do Not Abbreviate)
I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying
statements or forms, and it is true and correct to the best of my knowledge.
17
YOUR SIGNATURE
YOUR RELATIONSHIP TO THE PERSON IN ITEM 1 IS:
18
Legal
Other
Self
Natural Or
Adoptive Parent
Guardian
Specify
DO NOT WRITE BELOW THIS LINE (FOR SSA USE ONLY)
NPN
DOC
NTI
CAN
ITV
PBC
EVI
EVA
EVC
PRA
NWR
DNR
UNIT
SIGNATURE AND TITLE OF EMPLOYEE(S)
EVIDENCE SUBMITTED
REVIEWING EVIDENCE AND/OR CONDUCTING
INTERVIEW
DATE
DCL
DATE
U.S. Social Security Administration United States Federal Legal Forms United States Legal Forms

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