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If you download, print and complete a paper form, please mail or take it to your local Social Security office or the office that requested it from you. Important Note: PDFs you open from this page may default to opening within a browser, depending on your browser settings.
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.
You can complete an application for Retirement, Spouse's, Medicare or Disability Benefits online. If you cannot submit your application online: You can call us at 1-800-772-1213 (TTY 1-800-325-0778); or. Due to the COVID-19 pandemic, visits to our offices are by appointment only for certain services.
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (SSI) Note: Social Security Administration staff or others who help people apply for SSI will fill out this form for you. I am/We are applying for Supplemental Security Income and any federally administered state supplementation under Title XVI of the Social Security Act, for benefits
If you cannot use our online services to get a replacement Social Security card, you must visit a Social Security ofice or Card Center. You will need to complete an Application for a Social Security Card (form SSA-5) available at www.ssa.gov/forms/ss-5.pdf.
Please read the enclosed instructions before completing this form to help you answer each question. 1. Were you (the payee) convicted of a crime considered to be a felony between and ?
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. OMB No. 0960-0066.