Fillable Printable Application for a Social Security Card (Outside of the U.S.)
Fillable Printable Application for a Social Security Card (Outside of the U.S.)
Application for a Social Security Card (Outside of the U.S.)
Form SS-5-FS (08-2011) ef (08-2011) Destroy Prior Editions
SOCIAL SECURITY ADMINISTRATION
Application for a Social Security Card
Page 1
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 contact any U.S. Social Security office, U.S. Embassy or consulate or the
Veterans Affairs Regional Office (VARO) in Manila. For information about services outside the U.S.,
visit our website at www.socialsecurity.gov/foreign
.
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 mayprovide 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 documentsyou must provide, please
contact any U.S. Social Security office, U.S. Embassy or consulate or VARO. For information about
services outside the U.S., visit our website at www.socialsecurity.gov/foreign.
Page 2
EVIDENCE DOCUMENTS
The followinglists 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, U.S. Embassy or consulate or VARO 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 authorityto 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 bythe custodian of the original record. Notarized copies or photocopies which have not been
certified bythe custodian of the record are not acceptable. The U.S. Embassy or consulate, military office
or VARO will make certified copies of your original documents to mail to the Social Security Administration
along with this application. 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:
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 willbe shown on
the Social Securitycard. Generally, we prefer to see documents issued in the U.S. Documents you submit to
establish identity must showyour 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, wemust 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.
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 willnotify DHS. See page 3, item 5 for more information.
Form SS-5-FS (08-2011) ef (08-2011)
Page 3
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-explanatoryor 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 agencythat explains why you need a Social Securitynumber 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 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 verycarefully.
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 currentlyshown on your Social
Securityrecord, 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 byincluding additional information on the signature line
as this mayinvalidate your application. Contact 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 anySocial Security
office, U.S. Embassyor consulate or VARO. 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.
Form SS-5-FS (08-2011) ef (08-2011)
Page 4
PROTECT YOUR SOCIAL SECURITY NUMBER AND CARD
Protect your SSN card and number from loss and identitytheft. DO NOT carry your SSN card with you.
Keep it in a secure location and only take it with you when you must showthe card; e.g., to obtain a new
job, open a newbank 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, authorize us to collect this
information. The information you provide will be used to assign you a Social Security number and issue
a Social Security card.
The information you furnish on this form is voluntary. However, failure to provide the requested
information may prevent us from issuing you a Social Security number and card.
We rarely use the information you supply for any purpose other than for issuing a Social Security
number and card. However, we may use it for the administration and integrity of Social Security
programs. We may also disclose information to another person or to another agency in accordance
with approved routine uses, which include but are not limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing rights to Social
Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social Security records
(e.g., to the Government Accountability Office and Department of Veterans' Affairs);
3. To make determinations for eligibility in similar health and income maintenance programs at
the Federal, State, andlocal level; and
4. To facilitate statistical research, audit or investigative activities necessary to assure the
integrity of Social Security programs.
We may also use the information you provide in computer matching programs. Matching programs
compare our records with records kept by other Federal, State, or local government agencies.
Information fromthese matching programs can be used to establish or verify a person's eligibility for
Federally-funded or administered benefit programs and for repayment of payments or delinquent debts
under these programs.
Complete lists of routine uses for this information are available inSystem of Records Notice 60-0058
(Master Files of Social Security Number (SSN) Holders and SSN Applications). The Notice, additional
information regarding this form, and information regarding our systems and programs, are available
on-line at www.socialsecurity.gov
or at any U.S. Embassy, consulate, VARO, or U.S. Social Security
office.
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. You may send comments
on our time estimate to: SSA,6401 Security Blvd., Baltimore, MD 21235-6401. Send onlycomments
relating to our time estimate to this address, not the completed form.
Form SS-5-FS (08-2011) ef (08-2011)
Form SS-5-FS (08-2011) ef (08-2011) DestroyPrior Editions
SOCIALSECURITY ADMINISTRATION
Application for a Social Security Card
Form Approved
OMB No. 0960-0066
Page 5
1
NAME
TO BE SHOWN ON CARD
FirstFull Middle NameLast
FULL NAME AT BIRTH
IF OTHER THAN ABOVE
First
Full Middle NameLast
OTHER NAMES USED
2
Social Security number previously assigned to the person
listed in item 1
3
PLACE
OF BIRTH
(Do Not Abbreviate)
CityState or Foreign Country
Office
Use
Only
FCI
4
DATE
OF
BIRTH
MM/DD/YYY
Y
5
CITIZENSHIP
(Check One)
U.S. Citizen
Legal Alien
Allowed To
Work
Legal Alien Not
AllowedToWork(See
Instructions On Page 3)
Other (See
Instructions On
Page 3)
6
ETHNICITY
Are You Hispanic or Latino?
(Your Response is Voluntary)
YesNo
7
RACE
Select One or More
(Your Response is Voluntary)
Native Hawaiian
American Indian
Other Pacific Islander
Alaska Native
Black/African AmericanWhite
Asian
8
SEX
MaleFemale
9
A. PARENT/ MOTHER'S
NAME AT HER BIRTH
FirstFull Middle NameLast
B. PARENT/ MOTHER'S SOCIAL SECURITY
NUMBER
(See instructions for 9 B on Page 3)
Unknown
10
A. PARENT/ FATHER'S
NAME
FirstFull Middle NameLast
B. PARENT/ FATHER'S SOCIAL SECURITY
NUMBER
(See instructions for 10B on Page 3)
Unknown
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 12-13)No
Don't Know (If "don't know,"
skip to question 14.)
12
Name shown on the most recent Social
Security card issued for the person
listed in item 1
FirstFull Middle NameLast
13
Enter any different date of birth if used on an
earlier application for a card
MM/DD/YYYY
14
TODAY'S
DATE
MM/DD/YYYY
15
DAYTIME PHONE
NUMBER
( ) -
Area Code
Number
16
MAILING ADDRESS
(Do Not Abbreviate)
Street Address, Apt. No., PO Box, Rural Route No.
CityState/Foreign Country
ZIP Code
-
I declare under penalty of perjurythat I haveexamined 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
18
YOUR RELATIONSHIP TO THE PERSON IN ITEM 1 IS:
SelfNatural Or
Adoptive Parent
Legal
Guardian
Other (Specify)
DO NOT WRITE BELOW THIS LINE (FORSSA USE ONLY)
NPNDOCNTICANITV
PBCEVIEVAEVCPRANWRDNRUNIT
EVIDENCE SUBMITTED
SIGNATURE AND TITLE OF EMPLOYEE(S) REVIEWING
EVIDENCE AND/OR CONDUCTING INTERVIEW
DATE
DCLDATE
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