About this Form:

The SS-5 form is used to apply for a new social security card, apply for a replacement social security card, or to change or correct information on your social security card.

How do I fill out Form SS-5?

Starting at line 1, enter your full name given to you at birth. Make sure you input the name you had before you changed your name due to marriage or divorce. The Social Security Administration needs this information to locate the record of your previous social security card. If you are a female, this means you will need to enter your maiden name if you took your husband’s last name. Onto line 2, enter your Social Security Number, if you have one. If you do not, leave line 2 blank. Next, on line 3 fill in your place of birth. Do not abbreviate any of the names. Line 4 ask for your date of birth. Enter it with two digits for the month, two digits for the day, and four digits for the year. If your birthday is August 5, 1980, your date of birth will look like 08/05/1980. On line 5, you are being asked to select your citizenship status. Select if you are a U.S citizen, legal alien allowed to work, legal alien not allowed to work, or you are none of the mentioned where you select other. Select only one option. Line 6 is optional and is asking if you are of Latino or Hispanic origin. Answer Yes and No at your own discretion. Line 7 is also optional and is asking you to select your race; Native Hawaiian, Alaska Native, Asian, American Indian, Black/African American, other Pacific Islander or white. Again, you may choose to ignore this section. Line 8 is asking for your sex, male or female. Check the appropriate box. Lines 9 and 10 are optional if you are over 18 years old. If you are over 12 years old, you must complete these forms and turn them in in-person with your parent(s) or guardian(s). If you are under 18, on line 9a, enter your Mother’s first, middle, and last name at the time of her birth. Under that on 9b, enter your mother’s social security number. If it is unknown, check the box ‘Unknown’. Same as your mother’s information, on line 10a, fill in your father’s full name and social security number in sections 10a and 10b respectively. It also has the unknown selection in 10b. Again, these fields are not mandatory if you are over 18 years old. If you are applying to change your name on your current Social Security Card, you must answer line 11. Choose yes for line 11 because you have filed and received a social security number before, and move on to line 12. On line 12, enter your most recent first, middle, and last name listed on your social security card. This is usually the same name that is on the card you currently have. For line 13, if your birth date was corrected in the past, please make sure you input the date you had before that change. If you got your birth date correct on the first application, leave it blank if not enter the birth date you entered in your last application. Moving to line 14, enter today’s date; the day you are applying for a name change. On line 15, enter your enter your daytime phone number, please make sure it is correct as the social security administration may contact you directly. Line 16 is asking for your full mailing address. Do not use abbreviations.Enter your mailing address, and please make sure it is correct as this is where you will receive your social security card in approximately 14 days. Line 17 is for your signature. Finally, line 18 is asking for the relationship to the applicant. If you are filling this out for yourself, check ‘self’. Otherwise, choose the appropriate option: Natural or adoptive parent, legal guardian, or other. If other you must specify the relationship. You have now completed Form SS-5.