Use this letter to request evidence (age, identity, and U.S. citizenship) from U.S.-born applicants for:

• •

  Original SSN

• •

  Replacement SSN cards

• •

  Change of name SSN cards, and

• •

  Corrections to information on a Social Security number record

U.S. born applicants include people born in one of the 50 States, District of Columbia, Puerto Rico, Guam, American Samoa, Swain's Island and the U.S. Virgin Islands.

(See details: RM 10210.010 through RM 10210.020)

1. 1. 

   Enter DO address, hours, and phone number.

2. 2. 

   Enter applicant's mailing address.

3. 3. 

   Check the appropriate block(s).

1. 1. 

   If form SS-5 has already been received, return it with the letter. The applicant should then resubmit the SS-5 and evidence together.

2. 2. 

   If letter is being sent as the result of a request for an SSN application, enclose a blank form SS-5.

To view this form, go to SSA-L669.