Enumeration at Birth - Hospital Staff Relaying State Birth Certificate Data to SSA

Application for a Social Security Card

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0066 can be found here:

Documents and Forms

Document Name Document Type
Parent Worksheet - Current Template for State Issued EAB Request for an SSN.pdf Other-Template SSA Sends to States for Use with EAB Requests
Sample State form for EAB (Michigan Parent Information Worksheet).pdf Other-Sample Form for EAB (currently in use in Michigan)

Information Collection (IC) Details