INSTRUCTIONS : APPLICATION FOR A SOCIAL SECURITY CAR (Form SS-5)
(USE PAGE 5 ONLY)

A Form SS-5 is a Social Security form is used for the application of a social security card. The form should be used by people who have never had a social security card or who have lost or damaged their social security card.

The Form SS-5 is available through the social security administration, either through their website or by contacting a local branch office of the Social Security Administration.
The application for a new social security card is a one page form which must be completed. However, if you are applying for your first social security card, you must submit documentation to prove citizenship and age through birth certificates, driver's license, identity card, or a U.S. Passport.

1. Fill out box 1, providing your full name to appear on the card, your name given at birth, and any other names you have used.

2. If you have previously had a social security number assigned to you, provide it in box 2.

3. In boxes 3 and 4, provide your place and date of birth, using the MM/DD/YYYY format.

4. State your citizenship in box 5. If you are not a U.S. citizen, please note you must follow additional instructions found through the Social Security Administration.

5. Provide your ethnicity, race, and gender in boxes 6 through 8.

6. You must provide your parent's names and their social security numbers. You can check unknown, however this may require additional documentation to prove your citizenship, so try your best to locate their social security numbers.

7. Choose whether you have previously applied for a social security card in box 11. If yes, you must answer the additional questions in boxes 12 and 13.

8. Provide the date and your contact information in the next boxes.

9. You may now sign the Form SS-5. Indicate if you filled out the form on behalf of another and check your relationship in box 18.

10. You Form SS-5 is now ready for submission to the Social Security Administration.