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Use this form 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.

Citizenship
What is the applicant’s citizenship status?
- U.S. Citizen
- Legal Alien Allowed To Work
- Legal Alien NOT Allowed To Work
- Other

Parents’ Information
Mother’s name at her birth:
Name
First Name : Middle Name : Last Name :
Mother Social Security number:

When applying for an original Social Security card for a minor under age 18,
Father’s name at her birth:
Name
First Name : Middle Name : Last Name :
Father Social Security number:

Final Details:
Has the applicant or anyone acting on his/her behalf ever filed for or received a Social Security number card before?
- Yes
- No
- Don't Know
Name shown on the most recent Social Security card issued for the applicant:
Enter any different date of birth if used on an earlier application for a card
MM slash DD slash YYYY

If the date is different from the date of birth currently shown on your Social Security record, show the date of birth currently shown on your record and provide evidence of the birth date.
What is your relationship with the applicant?
- Self
- Natural or Adoptive Parent
- Legal Guardian
- Other
Details

Applicant’s Information