New Card New Social Security Card For Children Ages 12 and Under Step 1 of 8 0% Age*How old is the applicant? - Enter 0 if less than one year old - Unfortunately you can not use our services. You have to apply in person. Social Security Administration requires that all persons 12 years of age or older that have never received a social security number before must apply in person at the local Social Security Office. Zip Code*Please enter your home zip code to determine if your area is eligible for home requests. YOUR AREA IS NOT ELIGIBLE FOR MAILED SOCIAL SECURITY APPLICATIONS. You must apply in person at your local Social Security office. Gender*MaleFemaleFirst Name (Required)*Please enter applicant's First Name as you want it to appear on the Social Security Card.Middle Name (optional)Please enter applicant's Middle Name as you want it to appear on the Social Security Card.Last Name (Required)*Please enter applicant's Last Name as you want it to appear on the Social Security Card.Did you have a different name at birth?*NoYesBirth First NameBirth Middle NameBirth Last NameAre you using other names?*Have you ever used a different name?NoYesOther First NameOther Middle NameOther Last Name Applicant's Citizenship*Is the applicant a U.S Citizen?NoYesIs the applicant allowed to work legally in the U.S.?*NoYesDid the applicant enter the U.S. legally?*NoYesCountry of Birth*Please select applicant's country of birth:AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweState of birth*Please select applicant's state of birth:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaArmed Forces AmericasArmed Forces EuropeArmed Forces PacificState of birth (Foreign)*Please enter applicant's state of birth:City of birth*Please enter applicant's city of birth:Date of birth*Please enter applicant's date of birth:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Mother's First Name*Mother's Last Name*Do you know the mother's Social Security number?*NoYesEdit Mother SS NumberYesNoMother's Social Security number*E-FORMS DOES NOT STORE THE SOCIAL SECURITY NUMBER. It is used for secure application generation purposes only.Father's First Name*Father's Last Name*Do you know the father's Social Security number?NoYesEdit Father SS NumberYesNoFather's Social Security number*E-FORMS DOES NOT STORE THE SOCIAL SECURITY NUMBER. It is used for secure application generation purposes only. Mailing Address*Enter the mailing address where you want to receive the Social Security Card Street Apartment, Suite City AlabamaAlaskaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Code Relationship with applicant:*SelfBiological or Adoptive Mother or FatherLegal GuardianOtherCommunication* By selecting this box I hereby acknowledge that I agree with all Terms and Conditions and Privacy Policy herein described. I also understand that the Social Security Administration supplies blank forms and instructions for new and replacement cards free of charge. Nevertheless I wish to use e-forms’ services with personalized instructions to fill out the SS-5 form alongside all additional services provided herein. Telephone number*Please enter your CELL PHONE number. We will contact you via voice or text in case any additional information is needed to complete your applicationE-mail address*We will send you updates regarding your application. Email Confirm Email ISP E-Package*Your SOCIAL SECURITY CARD Request will have the highest priority and your electronic package will be ready immediately. Price: $39.90 Included in your package, you'll get a Free Copy of the Exclusive Ebook "The 2019 Ultimate Social Security Retirement Guide" a Guide to Help You Maximize Benefits Method of Payment*Credit CardE-FORMS DOES NOT STORE YOUR FINANCIAL INFORMATION. It is used for secure transaction processing only.Credit Card Type*American ExpressDiscoverMastercardVisaCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Billing Address Same as Mailing Address Billing* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State ZIP Code CAPTCHA New Card was last modified: June 14th, 2019 by e-forms_us
