Pennsylvania Nursing Home Transition

1
Social Security Card
Pennsylvania Nursing Home Transition

• To get an original number and card or to replace
  a card that was lost or stolen
• Complete and Application for a Social Security
  Card (Form SS-5)
• Show evidence of your age, identity, U.S.
  citizenship (or immigration status and work
  eligibility)
• Go to the Social Security office with your
  application and documentation

Completing the Application
1. Use Blue or Black ink. Print Clearly. 2.
Use the address where you can receive the card in
10-14 days from now. 3. If you check Other,
you need to provide proof that you are entitled
to a federally-funded benefit for which a
Social Security number is required. 5. Providing
race/ethnic information is voluntary. 6. Show
the month, day and full (4-digit) year of birth.
(for example, 1982) 8. Mothers or fathers
social Security number is only necessary if you
are applying for a card for a child under
18. 16. You must sign the application yourself if
you are physically and mentally capable. 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.
Take this application with your evidence
documents to any Social Security office. Note
If you are over 18 and have never been assigned a
number before, you must apply in person.
2
Acceptable documents for proof of age
Acceptable document for proof of identity
Acceptable documents for proof of citizenship

• One of the Following
• Birth certificate (preferred).
• Hospital record of birth
• Religious record of birth made before age 5
  showing your age and date of birth
• Passport
• Adoption record

• One of the Following
• Drivers License
• State issued Non-driver Photo Identity Card
• U.S. Military Identity Card
• Employer ID Card
• Adoption Record
• U.S. Passport
• Health Insurance Card (not a Medicare card)
• School Identity Card

• One of the Following
• U.S. Birth certificate
• U.S. Passport
• Certificate of Naturalization
• or
• Certificate of Citizenship

Original documents or copies certified by the
custodian of the record are needed. Social
Security cannot accept photocopies or notarized
copies of documents. U.S. Citizenship Social
Security can accept most documents that show you
were born in the US. If you are a US citizen
born outside the US, show a US consular report of
birth, a US passport, a Certificate of
Citizenship or a Certificate of Naturalization.
Alien Status Social Security needs to see an
unexpired document issued to you by the
Department of Homeland Security, such as Form
1-551, 1-94, 1-688B or 1-766. S.S. cannot accept
a receipt showing you applied for the document.
If you are not authorized to work, S.S. can issue
you a Social Security Card only if you need the
number for a valid non-work reason. IMPORTANT-
You must have a Social Security Card before you
can apply for a license.