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If you download, print and complete a paper form, please mail or take it to your local Social Security office or the office that requested it from you. Important Note: PDFs you open from this page may default to opening within a browser, depending on your browser settings.
Applying for a Social Security Card is free! USE THIS APPLICATION 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.
I am/We are applying for Supplemental Security Income and any federally administered state supplementation under Title XVI of the Social Security Act, for benefits under the other programs administered by the Social Security Administration, and where applicable, for medical assistance under Title XIX of the Social Security Act.
You can complete an application for retirement, spouse's, Medicare, or disability benefits online. If you cannot submit your application online, call us at 1-800-772-1213 (TTY 1-800-325-0778) between 8 a.m. and 7 p.m..
If you cannot use our online services to get a replacement Social Security card, you must visit a Social Security ofice or Card Center. You will need to complete an Application for a Social Security Card (form SSA-5) available at www.ssa.gov/forms/ss-5.pdf.
To get a replacement Social Security card for a child, you can use our online Social Security number and card application available at www.ssa.gov/number-card. You will start the application online and complete the process in a local Social Security ofice or Card Center. You may be eligible to self-schedule an appointment at your local Social ...
You may use this form if you received a notice that your monthly Medicare Part B (medical insurance) or prescription drug coverage premiums include an income-related monthly adjustment amount (IRMAA) and you experienced a life-changing event that may reduce your IRMAA.