Social Security Name Change Form

The Social Security SS-5 application can be used to change your legal name. The procedure has to go through the court process in order to be effective.

Extracted Text for Proper Search

Form SS-5 (08-2011) ef (08-2011) Destroy Prior Editions
Application for a Social Security Card	
Page 1	
SOCIAL SECURITY ADMINISTRATION 	
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
IMPORTANT:  You MUST provide a properly completed application and the required evide\
nce before we  
can process your application. We can only accept original documents or d\
ocuments certified by the  
custodian of the original record. Notarized copies or photocopies which \
have not been certified by the  
custodian of the record are not acceptable. We will return any documents\
 submitted with your application.  
For assistance call us at 1-800-772-1213 or visit our website at  www.socialsecurity.gov .	
Original Social Security Card
To apply for an original card, you must provide at least two documents t\
o prove age, identity, and U.S. 
citizenship or current lawful, work-authorized immigration status. If yo\
u are not a U.S. citizen and do not 
have DHS work authorization, you must prove that you have a valid non-wo\
rk reason for requesting a 
card. See page 2 for an explanation of acceptable documents.
NOTE: If you are age 12 or older and have never received a Social Securi\
ty number, you must apply in 
person.
Replacement Social Security Card
To apply for a replacement card, you must provide one document to prove \
your identity. If you were born 
outside the U.S., you must also provide documents to prove your U.S. cit\
izenship or current, lawful, 
work-authorized status. See page 2 for an explanation of acceptable docu\
ments.
Changing Information on Your Social Security Record
To change the information on your Social Security number record (i.e., \
a name or citizenship change, or 
corrected date of birth) you must provide documents to prove your ident\
ity, support the requested change, 
and establish the reason for the change. For example, you may provide a \
birth certificate to show your 
correct date of birth. A document supporting a name change must be recen\
t and identify you by both your 
old and new names. If the name change event occurred over two years ago \
or if the name change 
document does not have enough information to prove your identity, you mu\
st also provide documents to 
prove your identity in your prior name and/or in some cases your new leg\
al name. If you were born outside 
the U.S. you must provide a document to prove your U.S. citizenship or c\
urrent lawful, work-authorized 
status. See page 2 for an explanation of acceptable documents.
LIMITS ON REPLACEMENT SOCIAL SECURITY CARDS
Public Law 108-458 limits the number of replacement Social Security card\
s you may receive to 3 per 
calendar year and 10 in a lifetime. Cards issued to reflect changes to y\
our legal name or changes to a work 
authorization legend do not count toward these limits. We may also grant\
 exceptions to these limits if you 
provide evidence from an official source to establish that a Social Secu\
rity card is required.
IF YOU HAVE ANY QUESTIONS
If you have any questions about this form or about the evidence document\
s you must provide, please visit 
our website at  www.socialsecurity.gov  for additional information as well as locations of our offices and 
Social Security Card Centers. You may also call Social Security at 1-800\
-772-1213. You can also find 
your nearest office or Card Center in your local phone book.

Form SS-5 (08-2011) ef (08-2011)	Page 2	
EVIDENCE DOCUMENTS	
The following lists are examples of the types of documents you must prov\
ide with your application and are not all 
inclusive. Call us at 1-800-772-1213 if you cannot provide these documen\
ts.
IMPORTANT  : If you are completing this application on behalf of someone else, you \
must provide evidence that  
shows your authority to sign the application as well as documents to pro\
ve your identity and the identity of the  
person for whom you are filing the application. We can only accept origi\
nal documents or documents certified by  
the custodian of the original record. Notarized copies or photocopies wh\
ich have not been certified by the  
custodian of the record are not acceptable.
Evidence of Age
In general, you must provide your birth certificate. In some situations,\
 we may accept another document that 
shows your age. Some of the other documents we may accept are:
●	U.S. hospital record of your birth (created at the time of birth)	
●	Religious record established before age five showing your age or date of\
 birth	
●	Passport	
●	Final Adoption Decree (the adoption decree must show that the birth inf\
ormation was taken from the original 
birth certificate)	
Evidence of Identity
You must provide current, unexpired evidence of identity in your legal n\
ame. Your legal name will be shown on 
the Social Security card. Generally, we prefer to see documents issued i\
n the U.S. Documents you submit to 
establish identity must show your legal name AND provide biographical in\
formation (your date of birth, age, or 
parents' names)  and/or physical information (photograph, or physical description - height, ey\
e and hair color, 
etc.). If you send a photo identity document but do not appear in perso\
n, the document must show your 
biographical information (e.g., your date of birth, age, or parents' na\
mes). Generally, documents without an 
expiration date should have been issued within the past two years for ad\
ults and within the past four years for 
children.
As proof of your identity, you must provide a:
●	U.S. driver's license; or	
●	U.S. State-issued non-driver identity card; or	
●	U.S. passport
If you do not have one of the documents above or cannot get a replacemen\
t within 10 work days, we may accept 
other documents that show your legal name and biographical information, \
such as a U.S. military identity card, 
Certificate of Naturalization, employee identity card, certified copy of\
 medical record (clinic, doctor or hospital), 
health insurance card, Medicaid card, or school identity card/record. Fo\
r young children, we may accept medical 
records (clinic, doctor, or hospital) maintained by the medical provid\
er. We may also accept a final adoption   
decree, or a school identity card, or other school record maintained by \
the school. 
If you are not a U.S. citizen, we must see your current U.S. immigration\
 document(s) and your foreign passport 
with biographical information or photograph.
WE CANNOT ACCEPT A BIRTH CERTIFICATE, HOSPITAL SOUVENIR BIRTH CERTIFICAT\
E, SOCIAL 
SECURITY CARD STUB OR A SOCIAL SECURITY RECORD as evidence of identity.	
Evidence of U.S. Citizenship
In general, you must provide your U.S. birth certificate or U.S. Passpor\
t. Other documents you may provide are a 
Consular Report of Birth, Certificate of Citizenship, or Certificate of \
Naturalization.
Evidence of Immigration Status
You must provide a current unexpired document issued to you by the Depar\
tment of Homeland Security (DHS) 
showing your immigration status, such as Form I-551, I-94, or I-766. If \
you are an international student or 
exchange visitor, you may need to provide additional documents, such as \
Form I-20, DS-2019, or a letter 
authorizing employment from your school and employer (F-1) or sponsor \
(J-1). 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 only if you need the number for a valid non-work reason. Y\
our card will be marked to show you 
cannot work and if you do work, we will notify DHS. See page 3, item 5 f\
or more information.

Form SS-5 (08-2011) ef (08-2011)	Page 3	
HOW TO COMPLETE THIS APPLICATION	
Complete and sign this application LEGIBLY using ONLY black or blue ink \
on the attached or 
downloaded form using only 8 ½” x 11” (or A4 8.25” x 11.7”\
) paper.
GENERAL:  Items on the form are self-explanatory or are discussed below. The numbe\
rs match the  
numbered items on the form. If you are completing this form for someone \
else, please complete the  
items as they apply to that person.
4. Show the month, day, and full (4 digit) year of birth; for example, “\
1998” for year of birth.
5.    If you check “Legal Alien Not Allowed to Work” or “Other,\
” you must provide a document from a 
U.S. Federal, State, or local government agency that explains why you ne\
ed a Social Security number 
and that you meet all the requirements for the government benefit. NOTE:\
 Most agencies do not require 
that you have a Social Security number. Contact us to see if your reason\
 qualifies for a Social Security 
number.
6., 7. Providing race and ethnicity information is voluntary and is requ\
ested for informational and 
statistical purposes only. Your choice whether to answer or not does not\
 affect decisions we make on 
your application. If you do provide this information, we will treat it v\
ery carefully.
9.B., 10.B. If you are applying for an original Social Security card for\
 a child under age 18, you MUST 
show the parents' Social Security numbers unless the parent was never as\
signed a Social Security 
number.  If the number is not known and you cannot obtain it, check the \
“unknown” box.
13. If the date of birth you show in item 4 is different from the date o\
f birth currently shown on your 
Social Security record, show the date of birth currently shown on your r\
ecord in item 13 and provide 
evidence to support the date of birth shown in item 4.
16. Show an address where you can receive your card 7 to 14 days from no\
w.
17. WHO CAN SIGN THE APPLICATION? If you are age 18 or older and are phy\
sically and mentally 
capable of reading and completing the application, you must sign in item\
 17. If you are under age 18, 
you may either sign yourself, or a parent or legal guardian may sign for\
 you. If you are over age 18 and 
cannot sign on your own behalf, a legal guardian, parent, or close relat\
ive may generally sign for you. If 
you cannot sign your name, you should sign with an "X” mark and have \
two people sign as witnesses in 
the space beside the mark. Please do not alter your signature by includi\
ng additional information on the 
signature line as this may invalidate your application. Call us if you h\
ave questions about who may sign 
your application.	
HOW TO SUBMIT THIS APPLICATION	
In most cases, you can take or mail this signed application with your do\
cuments to any Social Security 
office. Any documents you mail to us will be returned to you. Go to  
https://secure.ssa.gov/apps6z/FOLO/fo001.jsp	
 to find the Social Security office or Social Security Card 
Center that serves your area.

Form SS-5 (08-2011) ef (08-2011)	Page 4	
PROTECT YOUR SOCIAL SECURITY NUMBER AND CARD	
Protect your SSN card and number from loss and identity theft. DO NOT ca\
rry your SSN card with you. 
Keep it in a secure location and only take it with you when you must sho\
w the card; e.g., to obtain a new 
job, open a new bank account, or to obtain benefits from certain U.S. ag\
encies. Use caution in giving 
out your Social Security number to others, particularly during phone, ma\
il, email and Internet requests 
you did not initiate.	
PRIVACY ACT STATEMENT
Collection and Use of Personal Information	
Sections 205(c) and 702 of the Social Security Act, as amended, author\
ize us to collect this 
information. The information you provide will be used to assign you a So\
cial Security number and 
issue a Social Security card.
The information you furnish on this form is voluntary. However, failure \
to provide the requested 
information may prevent us from issuing you a Social Security number and\
 card.
We rarely use the information you supply for any purpose other than for \
issuing a Social Security 
number and card. However, we may use it for the administration and integ\
rity of Social Security 
programs. We may also disclose information to another person or to anoth\
er agency in accordance 
with approved routine uses, which include but are not limited to the fol\
lowing:
1.To enable a third party or an agency to assist Social Security in establ\
ishing rights to 
Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from So\
cial Security 
records (e.g., to the Government Accountability Office and Department o\
f Veterans' 
Affairs);
3. To make determinations for eligibility in similar health and income main\
tenance 
programs at the Federal, State, and local level; and
4. To facilitate statistical research, audit or investigative activities ne\
cessary to assure the 
integrity of Social Security programs.
We may also use the information you provide in computer matching program\
s. Matching programs 
compare our records with records kept by other Federal, State, or local \
government agencies. 
Information from these matching programs can be used to establish or ver\
ify a person's eligibility 
for Federally-funded or administered benefit programs and for repayment \
of payments or 
delinquent debts under these programs.
Complete lists of routine uses for this information are available in Sys\
tem of Records Notice 
60-0058 (Master Files of Social Security Number (SSN) Holders and SSN\
 Applications). The 
Notice, additional information regarding this form, and information rega\
rding our systems and 
programs, are available on-line at  www.socialsecurity.gov or at any local Social Security office.
This information collection meets the requirements of 44 U.S.C. §3507\
, as amended by Section 2 of the 
Paperwork Reduction Act of 1995 . You do not need to answer these questi\
ons unless we display a 
valid Office of Management and Budget control number. We estimate that i\
t will take about 8.5 to 9.5 
minutes to read the instructions, gather the facts, and answer the quest\
ions. You may send comments 
on our time estimate to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6\
401.  Send only comments 
relating to our time estimate to this address, not the completed form.

Form SS-5 (08-2011) ef (08-2011) Page 5	
Form Approved  
OMB No. 0960-0066	SOCIAL SECURITY ADMINISTRATION   
Application for a Social Security Card
1	
NAME   
TO BE SHOWN ON CARD	
First Full Middle NameLast	
FULL NAME AT BIRTH  
IF OTHER THAN ABOVE	First Full Middle Name
Last	
OTHER NAMES USED 	
2	Social Security number previously assigned to the person 
listed in item 1	
3	
PLACE 
OF BIRTH
(Do Not Abbreviate)City State or Foreign Country	
Office 
Use 
Only
FCI	
4	
DATE 
OF 
BIRTH	
MM/DD/YYYY 	
5	CITIZENSHIP( Check One )	
U.S. Citizen	Legal Alien 
Allowed To 
Work	Legal Alien Not Allowed 
To Work(See 
Instructions On Page 3)	Other (See 
Instructions On 
Page 3)	
6	
ETHNICITY
Are You Hispanic or Latino? 
(Your Response is Voluntary)	
Yes	No	
7	
RACE
Select One or More          
(Your Response is Voluntary)	
Native Hawaiian
Alaska Native
Asian	
American Indian
Black/African 
American	
Other Pacific 
Islander
White	
8	SEX	Male	Female	
9	
A. PARENT/ MOTHER'S  
     NAME  AT HER BIRTH	First Full Middle NameLast 	
B. PARENT/ MOTHER'S SOCIAL  
     SECURITY NUMBER 	
(See instructions for 9 B on Page 3)	Unknown	
10	
A. PARENT/ FATHER'S  
     NAME	First Full Middle NameLast	
B. PARENT/ FATHER'S SOCIAL SECURITY 
     NUMBER 	
(See instructions for 10B on Page 3)	Unknown	
11	
Has the person listed in item 1 or anyone acting on his/her behalf ever \
filed for or received a Social Security number 
card before?	
Yes (If "yes" answer questions 12-13)	No	Don't Know (If "don't know," skip to question 14.)	
12	
Name shown on the most recent Social 
Security card issued for the person 
listed in item 1	First Full Middle NameLast	
13	Enter any different date of birth if used on an 
earlier application for a card	
MM/DD/YYYY	
14	
TODAY'S 
DATE	
MM/DD/YYYY	15	DAYTIME PHONE 
NUMBER	
Area CodeNumber	
16	MAILING ADDRESS
Do Not Abbreviate Street Address, Apt. No., PO Box, Rural Route No.
City	State/Foreign Country ZIP Code	
17	
I declare under penalty of perjury that I have examined all the informat\
ion on this form, and on any accompanying statements or forms,          \
      
and it is true and correct to the best to my knowledge.
YOUR SIGNATURE	
18	
YOUR RELATIONSHIP TO THE PERSON IN ITEM 1 IS:
Self	Natural Or         
Adoptive Parent	Legal  Guardian	Other 	Specify	
DO NOT WRITE BELOW THIS LINE (FOR SSA USE ONLY )
NPN DOCNTICAN ITV
PBC EVI EVAEVC PRANWR DNRUNIT
EVIDENCE SUBMITTED	
SIGNATURE AND TITLE OF EMPLOYEE(S) REVIEWING 
EVIDENCE AND/OR CONDUCTING INTERVIEW
DATE
DCL DATE	
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