SSA-5 Factsheet Webpage (mock-up)

SSA-5 Fact Sheet Webpage.pdf

Application for Mother's or Father's Insurance Benefits

SSA-5 Factsheet Webpage (mock-up)

OMB: 0960-0003

Document [pdf]
Download: pdf | pdf
Information You'll Need When You Apply for Mother's or Father's Benefits 	

Social Security Online
Forms Home Page

Introduction

Page 1 of3

Prepare for Your Interview 

Information You'll Need When You Apply for
Mother's or Father's Benefits
Whether it's by phone or in person, we want your
visit to go as smoothly as possible. You can help
by being ready to answer the following questions
and having as many of the needed documents as
possible.
We may also ask you to provide documents to
show that you are eligible:
• 	 Birth certificate or other proof of birth;
• 	 Naturalization papers;
• 	 U.S. military discharge paper{s);
• 	W-2 forms{s) and/or self-employment tax 

returns for last year. 

We accept photocopies of W-2 forms, self­
employment tax returns or medical documents, but
we must see the original of most other documents,
such as your birth certificate. (We will return them
to you.)
Don't delay filing your claim just because you don't
have all the documents. We'll help you get them.

When you apply for mother's or father's benefits,
we will ask you:
• 	 Your name and social security number;
• 	 The deceased worker's name, gender and 

social security number; 

• 	 Your name at birth (if different);
• 	 Your date of birth and place of birth (State or 

foreign country); 

• 	 Your citizenship status;
• 	 Whether you have used any other Social 

Security number; 

• 	 Whether you or anyone else has ever filed 

for Social Security benefits, Medicare or 

Supplemental Security Income on your 

behalf. (If so, we will also ask for information 

on whose Social Security record you 

applied); 

• 	 Whether you have ever worked for the

http://mwww.ba.ssa.gov/online/ssa-S.htrnl

6/8/2009

Information You'll Need When You Apply for Mother's or Father's Benefits 	

We ask marital
information to
determine eligibility
for various benefits
(i.e., spouse's,
widow(er)'s, etc.

Page 2 of3

railroad industry;
• 	Whether you became unable to work
because of illnesses, injuries or conditions at
any time within the past 14 months. If "Yes,"
we will also ask the date you became unable
to work;
• 	 Whether the worker has a surviving parent
who was dependent on the worker for 1/2 of
his or her support at the time of the worker's
death. (If "Yes", the name of the parent and
their address.);
• 	Whether you have earned social security
credits under another country's social
security system;
• 	 Whether you qualified for or expect to
receive a pension or annuity based on your
own employment with the Federal
government of the United States or one of its
States or local subdivisions;
• 	 The names, dates of birth (or age) and social
security numbers (if known) of any of your or
the worker's former spouses;
• The dates of each of your marriages and, for
marriages that have ended, how and when
they ended;
• The dates of each of the worker's marriages
and how and when they ended
• 	 The names of any unmarried children under
16 or 16 and older and disabled before age
22 in your care and the months the child
lived with you;
• 	 The amount of your earnings for this year,
last year and next year; and
• 	 Whether you and the deceased worker were
living together at the time of death; and
• 	 Whether you have any unsatisfied felony
warrants for your arrest or unsatisfied
Federal or State warrants for your arrest for
any violations of the conditions of your parole
or probation.
Depending on the information you provide, we may
need to ask other questions.
You also should bring along your checkbook or
other papers that show your account number at a
bank, credit union or other financial institution so
you can sign up for Direct Deposit, and avoid
worries about lost or stolen checks and mail
delays.

http://mwww.ba.ssa.gov/online/ssa-5.html

6/812009 


Infonnation You'll Need When You Apply for Mother's or Father's Benefits

Page 3 of3

Privacy Policy I Website Policies & Other Important Information I Site Map N d Larner Text?
Last reviewed or modified Wednesday Apr 01, 2 0 0 g E ' ! E ' L = _ _,­

http://mwww.ba.ssa.gov/online/ssa-S.html

6/8/2009


File Typeapplication/pdf
File Modified2009-06-08
File Created2009-06-08

© 2024 OMB.report | Privacy Policy