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Social Security Card Application Please complete this form to prepare your social security card application document.
Reason for Applying
Select your reason for applying:

• Replacing a lost or damaged card. This is a common occurrence. The Social Security Administration will issue up to three replacement cards per year.

• Updating a card to reflect a name change due to marriage or divorce. This is also a common occurrence, and does not count toward your replacement card limit.

• Updating or correcting other card information such as work authorization status or date of birth.

• Filing for an original, first-time social security card for someone who has never had one before, such as an immigrant or newborn child. This is the only case in which a new social security number is assigned. For all other reasons above, the cards will reflect the previously existing social security number.
Select the signer's relationship to the applicant.
Applicant's Full Name Please enter the applicant's first name to be shown on the new card.
Applicant's Full Name Please enter the applicant's middle name to be shown on the new card.
Applicant's Full Name Please enter the applicant's last name to be shown on the new card.
Applicant's Full Birth Name Please enter the applicant's first name at birth. For example, this could be a maiden name.
Applicant's Full Birth Name Please enter the applicant's middle name at birth. For example, this could be a maiden name.
Applicant's Full Birth Name Please enter the applicant's last name at birth. For example, this could be a maiden name.
Applicant's Gender Please select the applicant's gender.
Birth Date Please select the applicant's date of birth.
Birth Date Please select the applicant's date of birth.
Birth Date Please select the applicant's date of birth.
Birth Date Please select the applicant's date of birth.
Birth Country Please select the country the applicant was born in.
Birth State Please select the state the applicant was born in.
Birth City Please enter the city the applicant was born in (do not abbreviate).
Previous Card Full Name Please enter the first name shown on the applicant's most recently issued social security card.
Previous Full Name Please enter the middle name shown on the applicant's most recently issued social security card.
Previous Full Name Please enter the last name shown on the applicant's most recently social security card.
Social Security Number Please enter the social security number previously assigned to the applicant.

A Social Security Number is a nine digit number in the format ###-##-####.
Birth Date Please select the applicant's date of birth used in the application for the previous card.
Birth Date Please select the applicant's date of birth used in the application for the previous card.
Birth Date Please select the applicant's date of birth used in the application for the previous card.
Birth Date Please select the applicant's date of birth used in the application for the previous card.
Mother's Full Birth Name Please enter the first name of the applicant's mother at her birth. For example, this could be a maiden name.
Mother's Full Birth Name Please enter the middle name of the applicant's mother at her birth. For example, this could be a maiden name.
Mother's Full Birth Name Please enter the last name of the applicant's mother at her birth. For example, this could be a maiden name.
Mother's Social Security Number Please enter the social security number of the applicant's mother.

A Social Security Number is a nine digit number in the format ###-##-####.
Father's Full Name Please enter the first name of the applicant's father.
Father's Full Name Please enter the middle name of the applicant's father.
Father's Full Name Please enter the last name of the applicant's father.
Father's Social Security Number Please enter the social security number of the applicant's father.

A Social Security Number is a nine digit number in the format ###-##-####.
Mailing Address Please enter the street address, apartment number, PO box, or rural route number the social security card will be mailed to.
Mailing State Please select the state of the address the social security card will be mailed to.
Mailing City Please enter the city of the address the social security card should be mailed to (do not abbreviate).
Mailing Zip Please enter the zip code of the address the social security card should be mailed to.

Zip codes can be five numbers long, or nine numbers long with a dash after the first five numbers. For example, 12345 or 12345-6789.
Mailing County Please select the county of the address the social security card should be mailed to.
Contact Phone Please enter a phone number where you can be contacted.
Contact E-Mail Enter your e-mail address. E-mail is the primary method of correspondence for this order, so please make sure the e-mail address is accurate. The phone number is used as a backup method of correspondence only if a problem is discovered with the e-mail address.
Birth Name Select "Yes" if the applicant's name at birth was the same as the name entered above which will be displayed on the card. Select "No" to enter the applicant's name at birth if it was different.
Previous Card Name Select "Yes" if the applicant's name on the previous card was the same as the name entered above which will be displayed on the new card. Select "No" to enter the name shown on the applicant's previous card if it was different.
US Citizenship Select "Yes" if the applicant is a citizen of the United States. Select "No" if the applicant is not.
Legal Status Select "Yes" if the applicant is legally in the United States. Select "No" if the applicant is not.
Work Status Select "Yes" if the applicant is legally allowed to work in the United States. Select "No" if the applicant is not.
Previous Social Security Card Select "Yes" if the applicant has already been assigned a social security number and card. Select "No" if this will be the applicant's first card.
Update Card Info Select "Yes" if the information on the previous card was all correct. Select "No" your reason for applying is to change information on the previous card.
Previous Card Birth Date Select "Yes" if the applicant's date of birth given in the previous application was different than the date of birth used on this application. Select "No" if the same date of birth was used on both applications.
Mother's SSN Select "Yes" if the mother of the applicant was ever issued a social security number. Select "No" if she never had one.
Father's SSN Select "Yes" if the father of the applicant was ever issued a social security number. Select "No" if he never had one.
Signer Information Select "Yes" if the applicant is old enough and capable of signing the document.

Select "No" if the applicant is not capable and someone else will be signing for them.

Physical separation such as incarceration may sometimes qualify for a physical inability to sign.

Social Security Card Application Preparation



Reason for Applying

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