Form SSA-4-BK Application for Child's Insurance Benefits

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Form SSA-4-BK Application for Child's Insurance Benefits

What Is Form SSA-4-BK?

Form SSA-4-BK, Application for Child's Insurance Benefits , is a form that is used to apply for Child's Insurance Benefits on behalf of children.

Alternate Name:

  • Child Insurance Benefits Application.

This form was released by the Social Security Administration (SSA) and the latest version was issued on January 1, 2017 . A fillable Child Insurance Benefits Application is available for download below.

A child is eligible to get these benefits if they have:

  • A disabled or retired parent, entitled to Social Security benefits; or
  • A deceased parent who has died after paying enough Social Security taxes.

Child Insurance Benefits can be applied for on behalf of the applicant's natural children, their stepchild, grandchild, step-grandchild, and adopted child. The SSA-4-BK Form can be completed by a parent of a child or on behalf of a deceased parent.

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Form SSA-4-BK Instructions

To qualify for Child's Insurance Benefits a child should be unmarried and meet the following conditions:

  • Be younger than 18;
  • Be 18-19 years old and a full-time student (no higher than grade 12); or
  • Be 18 or older and disabled. Their disability, in this case, must have begun before age 22.

Form SSA-4-BK instructions are as follows:

  1. 1 - 2. Enter full names and Social Security numbers of the SSA worker and the eligible applicant.

  2. Part 1 - Information about the worker's children:

    • 3 - 5. Provide information about the children who are eligible for Benefits;
    • 6 - 7. Indicate if you are the natural or adoptive parent of the indicated children, provide information about the presence of any other adoptive parents;
    • 8. Indicate the children are not living with them now;
    • 9. Indicate if any child in Item 3 has ever been married;
    • 10. Provide information about anyone who has ever filed for Benefits on behalf of these children;
    • 11 - 13. Enter the amount of each child's current and expected earnings over the exempt amount for this year, last year and next year;
    • 14. Indicate the name of a child who uses a fiscal year (one that does not end on December 31);
    • 15. Provide information about any children in Item 3 adopted by the worker;
    • 16. Indicate any child who did not live with them during the last 13 months;
    • 17. Respond regarding filing for Supplemental Security Income.
  3. Part 2 - Information about the deceased. Complete items 18 through 26 regarding the deceased worker only.

    • 18 - 24. Provide information about this person;
      1. Indicate the earnings of the deceased in the year of death and the year before death;
      1. If there are any earnings of the deceased worker that are not yet on their earning records, indicate it in this Item;
      1. Indicate if the worker has ever filed for Social Security benefits;
      1. Note if the person was unable to work because of a disabling condition;
      1. Provide information about any children of the deceased not living with them at the time of death.
  4. Sign the form, enter your full name and phone number.

  5. Provide Direct Deposit Payment information.


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Download Form SSA-4-BK Application for Child's Insurance Benefits

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