SSA SS-5 Template Access SSA SS-5 Editor Now

SSA SS-5 Template

The SSA SS-5 form serves as the initial application for a Social Security Card, a vital piece of identification that enables individuals to work, collect Social Security benefits, and access other government services. It's the cornerstone for establishing legal identity and employment eligibility in the United States. For those looking to navigate through the application process smoothly, clicking the button below will guide you on how to accurately complete and submit your SSA SS-5 form.

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Table of Contents

Applying for a Social Security card, whether it's for the first time, to request a replacement, or to change information on the current record, requires individuals to navigate through the process set by the Social Security Administration (SSA). Central to this process is the Form SS-5, a critical document that serves various purposes. This form is key for anyone needing to update their Social Security records due to changes in their life's circumstances, such as a change of name after marriage or divorce or correcting information on their Social Security record. Moreover, the form is vital for immigrants who are establishing their residency status in the U.S. and thus need to apply for a Social Security number (SSN) for the first time. The intricacies of the SS-5 form encompass not just the application for a new card but also embrace the need for meticulous attention to detail to avoid common pitfalls that can delay the process. Navigating the requirements, understanding the importance of accuracy in filling out the form, and knowing the impact that this document can have on an individual’s ability to work and access benefits in the U.S. are essential elements that highlight the significance of the SS-5 form in the broader context of managing one’s identity and legal statuses within the country.

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Form SS-5 (10-2021) UF

Page 1 of 5

Use (11-2019) UF Until Stock Is Exhausted

OMB No. 0960-0066

SOCIAL SECURITY ADMINISTRATION

Application for a Social Security Card

Applying for a Social Security Card is free!

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 (10-2021) 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 (10-2021) 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 does not affect decisions on your application. We request this information for research and statistical purposes, to ensure all our customers receive fair and equal treatment.

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 (10-2021) 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 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 and issuing you a new or replacement Social Security card.

We will use the information you provide to issue you a 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 Social Security number; and

To student volunteers, persons working under a personal services contract, and others when they need access to information in our records in order to perform their assigned agency duties.

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 Notices (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 between 5 and 60 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 regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden 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 (10-2021) UF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 5 of 5

Use (11-2019) UF Until Stock Is Exhausted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OMB No. 0960-0066

SOCIAL SECURITY ADMINISTRATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Application for a Social Security Card

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

 

 

 

 

First

 

 

 

 

 

 

 

Full Middle Name

 

 

 

 

 

 

 

 

Last

 

 

 

 

 

 

 

 

 

 

1

TO BE SHOWN ON CARD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FULL NAME AT BIRTH

 

First

 

 

 

 

 

 

 

Full Middle Name

 

 

 

 

 

 

 

 

Last

 

 

 

 

 

 

 

 

 

 

 

IF OTHER THAN ABOVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER NAMES USED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

Social Security number previously assigned to the person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

listed in item 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

PLACE OF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office

 

4

 

DATE

 

 

 

 

 

 

 

 

 

 

 

BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Use Only

 

 

OF

 

 

 

 

 

 

 

 

 

 

 

(Do Not Abbreviate)

City

 

 

 

 

 

 

State or Foreign Country

 

 

 

 

FCI

 

 

BIRTH

 

 

 

 

 

 

MM/DD/YYYY

5

CITIZENSHIP

 

 

 

 

U.S. Citizen

 

Legal Alien

 

 

 

Legal Alien Not Allowed To

 

 

 

 

Other (See

 

 

 

 

 

Allowed To

 

 

 

Work(See Instructions On

 

 

 

 

Instructions On

 

(Check One)

 

 

 

 

 

 

 

 

 

 

 

 

Work

 

 

 

 

 

 

Page 3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 3)

 

ETHNICITY

 

 

 

 

 

 

 

RACE

 

 

 

 

 

 

 

Native Hawaiian

 

 

American Indian

 

 

Other Pacific

6

Are You Hispanic or Latino?

 

7

 

Select One or More

 

 

 

Alaska Native

 

 

Black/African

 

 

 

 

 

 

Islander

(Your Response is Voluntary)

 

 

(Your Response

 

 

 

 

 

 

 

 

 

 

 

White

 

Yes

No

 

 

 

 

is Voluntary)

 

 

 

Asian

 

 

 

 

 

 

 

 

 

 

American

 

 

 

 

 

 

 

 

 

 

 

8

SEX

 

 

 

 

 

 

 

 

 

 

 

Male

 

 

 

 

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. PARENT/ MOTHER'S

 

 

 

First

 

 

 

 

 

 

 

 

 

Full Middle Name

 

 

 

 

 

 

Last

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9

NAME AT HER BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. PARENT/ MOTHER'S SOCIAL SECURITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NUMBER (See instructions for 9B on Page 3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. PARENT/ FATHER'S

 

 

 

First

 

 

 

 

 

 

 

 

 

 

Full Middle Name

 

 

 

 

 

 

Last

 

 

 

 

 

 

 

 

 

 

10

NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. PARENT/ FATHER'S SOCIAL SECURITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NUMBER (See instructions for 10B on Page 3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11

Has the person listed in item 1 or anyone acting on his/her behalf ever filed for or received a Social Security number card

before?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Don't Know (If "don't know," skip to question 14.)

 

Yes (If "yes" answer questions 12-13)

 

No

 

 

 

 

 

12

Name shown on the most recent Social

 

First

 

 

 

 

 

 

 

 

 

 

 

Full Middle Name

Last

 

 

 

 

 

 

Security card issued for the person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

listed in item 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13

Enter any different date of birth if used on an

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

earlier application for a card

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM/DD/YYYY

 

 

 

 

 

 

 

 

 

 

 

14

DATETODAY'S

 

 

 

 

 

 

 

 

15

NUMBERDAYTIME PHONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM/DD/YYYY

 

 

 

 

 

 

Area Code

 

Number

 

 

 

 

 

 

 

 

 

 

16

MAILING ADDRESS

Street

Address,

Apt. No., PO Box, Rural

 

Route No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

17

statements or forms, and it is true and correct to the best of my knowledge.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YOUR SIGNATURE

 

 

 

 

 

 

18

YOUR RELATIONSHIP TO THE PERSON IN ITEM 1 IS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Self

Natural Or

 

 

 

Legal

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EVIDENCE SUBMITTED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE AND TITLE OF EMPLOYEE(S)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REVIEWING EVIDENCE AND/OR CONDUCTING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INTERVIEW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DCL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

Form Breakdown

Fact Name Description
Purpose of Form SS-5 Used to apply for a Social Security card, whether it's a new card, replacement, or correction.
Who Needs to File Individuals who need an original Social Security number, those requiring a replacement card, or anyone needing to change or update personal information with the Social Security Administration.
Where to File The form can be submitted in person at any Social Security office or mailed directly to the Social Security Administration.
Governing Laws Form SS-5 is governed by federal law, as the Social Security Administration is a federal agency.

Guidelines on Filling in SSA SS-5

Filling out the SSA SS-5 form is an essential step for anyone applying for a Social Security Number (SSN) or seeking a replacement card. Whether it's your first time applying or you're updating your details, understanding how to correctly fill out this form will streamline the process and help avoid delays. Below is a step-by-step guide designed to navigate you through each section of the form, ensuring you provide all the necessary information accurately.

  1. Gather your personal information, including your full legal name, date of birth, and place of birth.
  2. Have proof of your identity ready. This could be a U.S. driver's license, state-issued non-driver identification card, or U.S. passport.
  3. If you are applying for a SSN for the first time, collect documents proving your U.S. citizenship or current lawful, work-authorized immigration status. This could be a U.S. birth certificate or a U.S. passport for citizens, and a lawful permanent resident card (I-551), work permit (I-766), or admission stamp in the unexpired foreign passport for immigrants.
  4. Print the SS-5 form from the Social Security Administration's website or pick up a copy from a local SSA office.
  5. Start by filling out your name as shown on your social security card. If you are applying for a new card, use the name on your birth certificate unless it has been legally changed.
  6. Fill in your full date of birth using the month/day/year format, and provide the city and state or foreign country of your birth.
  7. Check the appropriate box for your sex.
  8. Provide your parents’ names as they appear on your birth certificate. If either parent has a Social Security Number, include that information as well.
  9. Indicate your race/ethnicity if you're comfortable doing so. This information is voluntary and collected for statistical purposes only.
  10. Answer whether you've ever received a Social Security Number previously. If yes, provide the number if known.
  11. List your citizenship status (U.S. citizen, legal alien allowed to work, legal alien not allowed to work, or other).
  12. If applicable, provide information about your current lawful work-authorized immigration status, including any documents that verify this status.
  13. Include your mailing address to receive your card, and provide a contact phone number where you can be reached during business hours.
  14. Review your application to ensure that all information is correct and complete. Missing or incorrect information could delay processing.
  15. Sign and date the form. If you are filling it out on behalf of another person, you must also provide your address and relationship to the applicant.
  16. Submit the completed form along with the required documents to the nearest Social Security office. These can be submitted in person or by mail, though in-person submissions might offer the opportunity for immediate verification of documents, potentially speeding up the process.

Once you have submitted your SS-5 form and the necessary documentation, the Social Security Administration will verify your documents and information. After the verification process is complete, you will receive your Social Security Number or a replacement card typically within two weeks. Remember, keeping a copy of your submission and noting the date of submission might be helpful for your records or any follow-up with the SSA.

Learn More on SSA SS-5

What is the SSA SS-5 form used for?

The SSA SS-5 form is essential for anyone needing to apply for a new Social Security card, replace a lost or damaged card, change or correct information on their Social Security record. This includes changes like a name change due to marriage or divorce. It serves as the application form for these requests, ensuring that individuals can maintain accurate and up-to-date information with the Social Security Administration (SSA).

How can I obtain an SSA SS-5 form?

You have several options for obtaining an SSA SS-5 form. You can download it directly from the Social Security Administration's official website. It's also possible to pick up a copy at a local SSA office. If you prefer, you can call the SSA and request that a form be mailed to you. All these options are designed to ensure you can access the form in the most convenient way for you.

What information do I need to provide on the SSA SS-5 form?

Completing the SSA SS-5 form requires providing detailed personal information, including:

  • Your full legal name and any previous names, if relevant
  • Your Social Security number, if you have one
  • Place and date of birth
  • Citizenship status
  • Ethnicity and race (optional)
  • Information about your parents, including their names and Social Security numbers, if available
  • Your signature

This information helps the SSA accurately process your application and ensure that your Social Security records are current and correct.

Is there a fee to apply for a new or replacement Social Security card with the SSA SS-5 form?

There is no fee to apply for a new or replacement Social Security card. This service is provided free of charge by the Social Security Administration. It's important, however, to submit accurate and complete information to avoid delays in processing your application.

Can I submit the SSA SS-5 form online?

Yes, in most cases, you can submit the SSA SS-5 form online. This convenience allows you to apply for a new or replacement card from the comfort of your home. However, this option requires you to have a My Social Security account and meet specific eligibility criteria set by the SSA. For more details on online submission and to check if you qualify, visit the official SSA website.

What documents do I need to submit with the SSA SS-5 form?

When applying for a new or replacement Social Security card using the SSA SS-5 form, you must provide documents proving your identity, age, and U.S. citizenship or lawful immigrant status. Typically, this includes:

  1. A birth certificate or passport to prove age and citizenship.
  2. A government-issued photo ID like a driver's license or state ID to prove identity.

All documents must be either originals or copies certified by the issuing agency. Photocopies or notarized copies are not accepted.

How long does it take to receive a Social Security card after submitting the SSA SS-5 form?

After submitting the SSA SS-5 form, it typically takes 10-14 business days to receive your Social Security card in the mail. Processing times can vary, however, based on the volume of applications being handled and any issues with the submitted form or accompanying documents. If there's a delay beyond this time frame, you may contact the SSA directly for an update on your application status.

Common mistakes

When applying for a Social Security Card, individuals must complete Form SSA SS-5. Errors in this process can lead to delays or the denial of an application. Being mindful of common mistakes can help ensure a smoother experience. Here are seven frequently made mistakes:

  1. Not using the most current form - The Social Security Administration periodically updates the SSA SS-5 form. Applicants often make the mistake of using outdated versions, which can lead to processing delays.
  2. Filling out the form with incorrect information - Whether it's a misspelled name, wrong date of birth, or an incorrect Social Security number, inaccurate information can significantly delay the process.
  3. Leaving fields blank - It's important to complete all required fields. If a particular section does not apply, indicating this with a "N/A" (not applicable) is better than leaving it blank.
  4. Failure to use blue or black ink - The SSA requires that the SS-5 form be filled out in blue or black ink. Using other colors can lead to the form being unprocessable.
  5. Forgetting to sign and date the form - An unsigned or undated form is considered incomplete and will be returned.
  6. Not providing the necessary documentation - Along with the SS-5 form, applicants must provide documentation proving their identity, age, and citizenship or lawful alien status. Forgetting or failing to provide these can halt the application process.
  7. Submitting photocopies instead of original documents - The SSA requires original documents or copies certified by the issuing agency. Photocopies are not acceptable and will be rejected.

Common mistakes can be avoided by carefully reviewing the form instructions and ensuring all documentation is correct and complete before submission. This not only speeds up the process but also minimizes the chances of an application being denied or delayed.

Documents used along the form

When applying for or updating your Social Security Card (SSC) using the SSA SS-5 form, various other forms and documents are often needed to support your application. The process requires careful attention to detail to ensure that all required information is accurate and complete. Below, we'll explore several other forms and relevant documents typically associated with the SSA SS-5 form, shedding light on their purpose and importance in the process.

  • Birth Certificate: This serves as the primary document to establish your age, U.S. citizenship, or lawful alien status. It's required for all new Social Security Card applications.
  • U.S. Passport: Often used in conjunction with the SSA SS-5 form, a U.S. Passport can verify both your identity and U.S. citizenship, simplifying the documentation process.
  • Driver's License or State ID: These are common forms of identification that can be used to prove your identity. One of these documents is typically required if you are 18 years or older.
  • Immigration Documents: For non-U.S. citizens, various immigration documents, such as a Permanent Resident Card (I-551) or an Employment Authorization Document (EAD), are necessary to prove lawful presence and work eligibility in the United States.
  • Marriage Certificate or Divorce Decree: Necessary when changing your name due to marriage, divorce, or any other reason, to prove that the name change is legally recognized.
  • Adoption Decree: This document is essential for those who are updating their SSC due to an adoption. It proves the legal adoption and any name change resulting from the process.
  • Medical Records: In cases involving young children or in specific situations where additional verification of identity is needed, medical records may serve as secondary documentation.

Together, these documents work alongside the SSA SS-5 form to streamline the application or updating process for your Social Security Card. Ensuring that you have the right documents prepared can significantly simplify the process, reducing the likelihood of delays or complications. Always check the current requirements and documentation standards, as rules and acceptable forms of evidence can change over time.

Similar forms

  • IRS Form W-9

    This form is used to request a taxpayer identification number and certification. Similar to the SSA SS-5, which is used to apply for a Social Security number, both forms involve providing personal information to a government agency for the purpose of tax identification.

  • Form I-9, Employment Eligibility Verification

    The I-9 form is required by employers to verify an employee's identity and eligibility to work in the United States. Like the SSA SS-5 form, it requires personal identification information, underscoring their role in verifying individuals' identities for official purposes.

  • U.S. Passport Application Form DS-11

    This application is used to obtain a U.S. passport. Similar to the SS-5 form, it requires detailed personal information, including Social Security number, for the purpose of establishing identity.

  • State ID and Driver’s License Applications

    These applications are utilized to obtain a state identification card or driver's license. They share similarities with the SSA SS-5 form in that they require providing personal details, including a Social Security number, to verify the applicant's identity.

  • Voter Registration Forms

    These forms are used to register individuals to vote. Like the SS-5, they may request a Social Security number among other personal details, linking an individual’s identity to a civic process.

  • Selective Service Registration

    U.S. males must register with Selective Service upon turning 18. This registration, similar to the SSA SS-5, requires personal information including the Social Security number to ensure proper identification and compliance with the law.

  • Birth Certificate Request Forms

    To obtain a copy of a birth certificate, these forms require detailed personal information. Like the SSA SS-5 form, which is used to obtain a Social Security number at birth or after immigration, both documents are vital for identity verification purposes.

  • Medicare Enrollment Application

    This application is necessary for enrolling in Medicare. It shares the need for detailed personal and identification information with the SSA SS-5 form, including Social Security numbers, to enroll the individual in government healthcare programs.

  • Bank Account Opening Forms

    Similar to the SS-5, opening a bank account requires providing personal identification details, including a Social Security number. Both forms are essential for financial identity verification and fraud prevention.

Dos and Don'ts

Filing for a Social Security card is a process that requires precision. Whether applying for the first time, replacing, or making changes to an existing card, using the SSA SS-5 form is crucial. The following guidelines will help ensure that your application is completed correctly and efficiently.

Do's when filling out the SSA SS-5 form:

  1. Read the instructions provided with the SS-5 form carefully before filling it out. These instructions are there to guide you through each section, ensuring accuracy.
  2. Use black or blue ink only. This ensures that the information is legible and that automated processing systems can read your application without issues.
  3. Provide accurate and current information, particularly your full legal name, birth date, and Social Security number (if you have one). Incorrect information can delay the process.
  4. Include original documents or certified copies from the issuing agency for proof of identity, age, and citizenship. Photocopies and notarized copies are not acceptable.
  5. Verify all the information on the form before submitting it to avoid errors or omissions, which could lead to delays.
  6. Sign the form yourself unless you are unable to do so. In such cases, the application should be signed by a parent, guardian, or another authorized individual on your behalf.
  7. Keep a copy of the completed SS-5 form for your records. This helps in tracking the progress of your application and serves as proof of submission.
  8. Contact the Social Security Administration directly if you have questions or need assistance. They offer the most accurate and up-to-date information.

Don'ts when filling out the SSA SS-5 form:

  • Don’t leave any required fields blank. If a section does not apply, enter “N/A” (not applicable). Blank sections may cause unnecessary delays.
  • Don’t use correction fluid or tape. Mistakes should be neatly crossed out, and the correct information should be clearly written instead.
  • Don’t submit the form without the required documents. Missing documentation will halt the processing of your application.
  • Don’t guess information. If you’re unsure about what to enter in a field, it’s better to verify the information first or seek guidance from the Social Security Administration.
  • Don’t fold or staple the form and documents. This can damage them and interfere with the scanning process.
  • Don’t provide false information or documentation. This is illegal and can result in penalties, including fines and imprisonment.
  • Don’t rush through the form. Taking your time to fill out the form accurately is crucial to ensure your application is processed smoothly.
  • Don’t hesitate to ask for help. Completing government paperwork can be complex, and it’s important to get it right. Reaching out for assistance can save time and prevent mistakes.

Misconceptions

Many misconceptions surround the SSA SS-5 form, which is crucial for obtaining a Social Security card. It’s important to address these misunderstandings to ensure individuals can navigate the process efficiently and correctly. Here are four common misconceptions and the facts that dispel them:

  • Anyone can apply for a replacement card online. In reality, while online application services are available, they are not accessible to everyone. Individuals must meet specific criteria, such as having a U.S. mailing address, not requesting a name change or any other change to their card, and having a driver’s license or state-issued identification card from certain states.
  • The SS-5 form is only for those who have never had a Social Security number before. This is incorrect. The SS-5 form is used both for applying for a new Social Security number and for requesting a replacement card. It is also used for making changes to your record, such as a name change after marriage or adoption.
  • Completing the SS-5 form is enough to get a Social Security card. Simply filling out the form is not the end of the process. Original or certified copies of certain documents must also be provided to verify the applicant’s age, identity, and U.S. citizenship or lawful immigration status. Photocopies or notarized copies of documents are not accepted.
  • You must pay a fee to get a Social Security card. This is a common misconception. There is no fee to apply for a Social Security card, whether it’s your first card or a replacement. Some third-party services may charge a fee to assist with the application, but the Social Security Administration provides this service free of charge.

Key takeaways

The SSA SS-5 form is a critical document for anyone needing to apply for a Social Security card, whether it's a new application, a replacement, or an update to their current information. To navigate this process smoothly, here are some key takeaways:

  • Accuracy is paramount when filling out the SSA SS-5 form. Every detail matters, from your full name as it appears on your birth certificate (or legal identification) to your Social Security number, if you have one. Mistakes can lead to processing delays.
  • Supporting documents are required to verify your identity, age, and U.S. citizenship or immigration status. These can include a U.S. birth certificate, passport, or Permanent Resident Card, among others. Originals or certified copies are necessary; photocopies are not accepted.
  • The SSA SS-5 form can be submitted in various ways: in person at a local Social Security office, by mail, and in some circumstances, online. Choosing the right submission method can affect how quickly your application is processed.
  • If you're updating or correcting information on your Social Security record, be prepared to provide documentation supporting the change. For example, a marriage certificate for a name change or a naturalization certificate for a change in citizenship status.
  • While there's no fee to apply for a Social Security card, the importance of safeguarding your new card cannot be overstated. Once you receive your card, keep it in a secure place to protect your identity and personal information.

Understanding the nuances of the SSA SS-5 form and preparing your application carefully can greatly simplify the process of obtaining, replacing, or updating your Social Security card. Start by gathering all necessary documents and then proceed with filling out the form as clearly and accurately as possible. Remember, if you have questions or encounter difficulties, assistance is readily available through the Social Security Administration's website or your local Social Security office.

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