Appendix 400-19-165

 

Form SS-5, Application for a Social Security Number Card 400-19-165-05

(Revised 6/1/10 ML #3218)

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Form SS-5, Application for Social Security Number designed by the Social Security Administration, must be completed by anyone applying for a social security number (SSN) or for a replacement of a lost or destroyed card. It may also be used to request a change in an individual's social security record. A completed Form SS-5, ‘Application for Social Security Number’ and evidence of age, identity, and United States citizenship (or legal alien status) constitute a formal application for a number.

 

Form SS-5, ‘Application for Social Security Number’ may be made at any district office of the Social Security Administration. However, since each member of a TANF household must either have a number or prove that an application for a number has been made, county social service office staff may find it expedient to assist the applicant in completing the form. This will help to ensure that the form is completed properly and that unnecessary delays are avoided. The completed form, together with required evidence of age, identity, and citizenship may be either mailed or delivered personally by the applicant to the Social Security Administration's district office. In return, the county social service office will be notified by the district office via Form 5028, ‘Evidence of Application for Social Security Number Card’ or other means that these materials were received and that the application for an SSN will be processed.

 

Completion of Form SS-5, ‘Application for Social Security Number’, is largely self-explanatory although detailed instructions are attached to the form. The form must be dated and signed by the applicant. The state code (35), a two-digit county number, and zeros shall be entered with red ink on the line identified as "NPN" in the lower right-hand corner of the form. An illustration of a Burleigh County entry for TANF is 35-080000000. Any zero appearing in the case number must be shown with a vertical line drawn through (0) to allow the computer to distinguish it from the letter "0."

 

Application for a Social Security Number Card (82kb pdf)

 

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