Social Security Administration Application For A Social Security Card (Page 3 of 6) in pdf

NAME CHANGE: If your name is now different from the name shown on your card, we need an

identity document that identifies you by BOTH your old name AND your new name. Examples

include a marriage certificate, divorce decree, or a court order that changes your name. Or we can

accept two identity documents—one in your old name and one in your new name. (See IDENTITY

for examples of identity documents.)

U.S. CITIZENSHIP: We can accept most documents that show you were born in the U.S. If you are

a U.S. citizen born outside the U.S., show us a U.S. consular report of birth, a U.S. passport, a

Certificate of Citizenship, or a Certificate of Naturalization.

ALIEN STATUS: We need to see a current document issued to you by the U.S. Immigration and

Naturalization Service (INS), such as Form I-551, I-94, I-688B, or I-766. We CANNOT accept a

receipt showing you applied for the document. If you are not authorized to work in the U.S., we can

issue you a Social Security card if you are lawfully here and need the number for a valid nonwork

reason. Your card will be marked to show you cannot work, and, if you do, we will notify INS.

IF YOU HAVE ANY QUESTIONS: If you have any questions about this form, or about the

documents you need to show us, please contact any Social Security office. A telephone call will help

you make sure you have everything you need to apply for a card.

THE PAPERWORK/PRIVACY ACT AND YOUR APPLICATION

The Privacy Act of 1974 requires us to give each person the following notice when applying for a

Social Security number.

Sections 205(c) and 702 of the Social Security Act allow us to collect the facts we ask for on this

form.

We use the facts you provide on this form to assign you a Social Security number and to issue you a

Social Security card. You do not have to give us these facts, however, without them we cannot issue

you a Social Security number or a card. Without a number, you may not be able to get a job and

could lose Social Security benefits in the future.

The Social Security number is also used by the Internal Revenue Service for tax administration

purposes as an identifier in processing tax returns of persons who have income which is reported to

the Internal Revenue Service and by persons who are claimed as dependents on someone’s

Federal income tax return.

We may disclose information as necessary to administer Social Security programs, including to

appropriate law enforcement agencies to investigate alleged violations of Social Security law; to

other government agencies for administering entitlement, health, and welfare programs such as

Medicaid, Medicare, veterans benefits, military pension, and civil service annuities, black lung,

housing, student loans, railroad retirement benefits, and food stamps; to the Internal Revenue

Service for Federal tax administration; and to employers and former employers to properly prepare

wage reports. We may also disclose information as required by Federal law, for example, to the

Department of Justice, Immigration and Naturalization Service, to identify and locate aliens in the

U.S.; to the Selective Service System for draft registration; and to the Department of Health and

Form SS-5 Internet (2-98)

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Social Security Administration Application For A Social Security Card Page 3