Form SS-5-FS, Application for a Social Security Card Instructions
This form contains 74 fields organized into 29 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Alternate Birth Date Used | ||
| 13. Enter any different date of birth if used on an earlier application for ay card. m m/d d/ y y y y | Text | |
| Applicant Signature | ||
| 17 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. YOUR SIGNATURE a wet signature is required. print the form and sign | Text | |
| Birth Name (First Middle Last) | ||
| FULL NAME AT BIRTH IF OTHER THAN ABOVE First | Text | |
| Full Middle Name | Text | |
| Last | Text | |
| Card Name (First Middle Last) | ||
| Form SS-5-F S (12-2024) U F Discontinue prior editions SOCIAL SECURITY ADMINISTRATION Page 5 of 5 O M B Number 0960-0066 Application for a Social Security Card 1 NAME TO BE SHOWN ON CARD First | Text | |
| Full Middle Name | Text | |
| Last | Text | |
| Citizenship Status | ||
| 5. CITIZENSHIP. (Check One). U.S. citizen | CheckBox | |
| legal alien allowed to work | CheckBox | |
| Legal Alien Not Allowed To Work (See Instructions On Page 3) | CheckBox | |
| Other (See Instructions On Page 3) | CheckBox | |
| Date of Birth | ||
| office use only F C I. 4. Date of birth. m m/d d/ y y y y | Text | |
| Daytime Phone Number | ||
| 15. DAYTIME PHONE NUMBER. area code | Text | |
| first three digits of phone number (not including area code) | Text | |
| last four digits of phone number | Text | |
| Ethnicity Hispanic/Latino | ||
| 6. ETHNICITY. Are You Hispanic or Latino? (Your Response is Voluntary). yes | CheckBox | |
| no | CheckBox | |
| Father's Name | ||
| 10. Ay. Parent/ father's first name | Text | |
| Full middle name | Text | |
| Last | Text | |
| Father's SSN | ||
| 10. B. PARENT/ FATHER'S SOCIAL SECURITY NUMBER (See instructions for 10B on Page 3). First three digits of social security number | Text | |
| middle two digits of social security number | Text | |
| last four digits of social security number | Text | |
| unknown | CheckBox | |
| General | ||
| Form SS-5-F S (12-2024) U F Discontinue Prior Editions SOCIAL SECURITY ADMINISTRATION Page 1 of 5 O M B Number. 0960-0066 Application for a Social Security Card Applying for a Social Security Card is free! USE THIS APPLICATION TO: bullet Apply for an original Social Security card bullet Apply for a replacement Social Security card bullet 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, contact any U.S. Social Security office or your Federal Benefits Unit. For a complete list of Federal Benefits Units and contact information, visit www.socialsecurity.gov/foreign | Text | |
| 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 Department of Homeland Security (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 | Text | |
| IF YOU HAVE ANY QUESTIONS If you have any questions about this form or about the evidence documents you must provide, please contact any U.S. Social Security office or your Federal Benefits Unit. For a complete list of Federal Benefits Units and contact information, visit www.socialsecurity.gov/foreign | Text | |
| 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. Contact any U.S. Social Security office or your Federal Benefits Unit 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. Visit any U.S. Social Security office or your Federal Benefits Unit and they will make certified copies of your original documents. Do not mail your original documents to the Social Security Administration in Baltimore, Maryland. 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: bullet U.S. hospital record of your birth (created at the time of birth) bullet Religious record established before age five showing your age or date of birth bullet Passport bullet Final Adoption Decree (the adoption decree must show that the birth information was taken from the original birth certificate) | Text | |
| 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: bullet U.S. driver's license; or bullet U.S. State-issued non-driver identity card; bullet 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), your foreign passport, foreign driver's license or foreign ID card 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 | Text | |
| How to Complete This Application Jump Link | ||
| Page 3 of 5 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 item 5 for more information. 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 U.S. 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 | Text | |
| Item 13 Evidence Instruction Jump Link | ||
| 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. 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, generally a legal guardian, parent, or close relative may 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. Contact us if you have questions about who may sign your application. HOW TO SUBMIT THIS APPLICATION You can mail this signed application or take this signed application with your documents to any U.S. Social Security office or your Federal Benefits Unit. If you are a military dependent or a U.S. citizen working on a U.S. military post, you may also go to the Post Adjutant or Personnel Office. If you do not want to mail your original documents, take them along with this application to one of the offices listed above. The people there will make certified copies of your original documents and mail them to the Social Security Administration along with this application. Do not mail your original documents to the Social Security Administration in Baltimore, Maryland | Text | |
| Mailing Address | ||
| 16. Mailing address (do not abbreviate). Street Address, Apartment Number, P O Box, Rural Route Number | Text | |
| City | Text | |
| State/Foreign country | Text | |
| zip code | Text | |
| Mother's Name at Birth | ||
| 9 Ay. Parent/ mother's name at her birth. First | Text | |
| full middle name | Text | |
| last | Text | |
| Mother's SSN | ||
| 9. B. PARENT/ MOTHER'S SOCIAL SECURITY NUMBER (See instructions for 9 B on Page 3). First three digits of social security number | Text | |
| middle two digits of social security number | Text | |
| last four digits of social security number | Text | |
| unknown | CheckBox | |
| Name on Most Recent Card | ||
| 12. Name shown on the most recent Social Security card issued for the person listed in item 1. First | Text | |
| full middle name | Text | |
| last | Text | |
| Other Names Used | ||
| OTHER NAMES USED | Text | |
| Paperwork Reduction Act Statement Text | ||
| 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.g o v. 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 B l v d, Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form | Text | |
| Place of Birth | ||
| 3 PLACE OF BIRTH (Do Not Abbreviate) City | Text | |
| state or foreign country | Text | |
| Prior SSN (Applicant) | ||
| 2 Social Security number previously assigned to the person listed in item 1 First three digits of social security number | Text | |
| middle two digits of social security number | Text | |
| last four digits of social security number | Text | |
| Prior SSN Application Status | ||
| 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? Yes (If "yes" answer questions 12 dash 13 ) | CheckBox | |
| no | CheckBox | |
| Don't Know (If "don't know," skip to question 14.) | CheckBox | |
| Privacy Act Statement Text | ||
| PRIVACY ACT STATEMENT Collection and Use of Personal Information Sections 202, 205(c), and 702 of the Social Security Act (Act), as amended, allow us to collect this information, which we will use to assign a Social Security number, issue a Social Security card, and make a timely determination concerning eligibility for Social Security benefits. Providing the information is voluntary, but not providing all or part of the information may prevent us from assisting you. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notices (S O R N) 60-0058, 60-0090, 60-0103, and 60-0104, available at www.s s ay .g o v /privacy. The information you submit may also be used in computer matching programs to establish or verify eligibility for Federal benefit programs and to recoup debts under these programs. The Act also allows us to collect race and ethnicity information, which we will use for research and statistical purposes. Furnishing us this information is voluntary and will not be used in decisions about your application | Text | |
| Protect SSN Disclaimer Text | ||
| 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 | Text | |
| Race Selection | ||
| 7. RACE. Select One or More (Your Response is Voluntary). Native Hawaiian | CheckBox | |
| Alaska Native | CheckBox | |
| Asian | CheckBox | |
| American Indian | CheckBox | |
| Black/African American | CheckBox | |
| Other Pacific Islander | CheckBox | |
| white | CheckBox | |
| Relationship to Applicant | ||
| 18. YOUR RELATIONSHIP TO THE PERSON IN ITEM 1 IS. Self | CheckBox | |
| Natural Or Adoptive Parent | CheckBox | |
| Legal Guardian | CheckBox | |
| Other | CheckBox | |
| Specify other selection | Text | |
| Sex | ||
| 8. SEX. male | CheckBox | |
| female | CheckBox | |
| SSA Use Only DCL | ||
| DO NOT WRITE BELOW THIS LINE (FOR SSA USE ONLY). N P N. D O C. N T I, C Ay N. I T V. P B C. E V I. E V Ay. E V C. P R Ay. N W R. D N R. Unit. Evidence submitted. SIGNATURE AND TITLE OF EMPLOYEE(S) REVIEWING EVIDENCE AND/OR CONDUCTING INTERVIEW. Date. D C L. Date. End SSA use Only section. If you tab out of this field you will return to the beginning of the form | Text | |
| Today's Date | ||
| 14. TODAY'S DATE. m m/d d/ y y y y | Text | |