CAUTION: Before issuing Form SSA-5028, be certain that assignment of an SSN is proper. Verify
all necessary evidence of age, identity, and U.S. citizenship or lawful alien status.
In addition, do not issue the SSA-5028 to applicants whose SS-5's, (Application for
a Social Security Card) have codes “N,” “X,” or “Y.” For these applicants issue Form
SSA-5029, Application for a Non-Work Social Security Number.
You may key or write the following information on the SSA-5028.
Enter the applicant's name and the date of the SS-5 and the above listed information
and when received by the district office (DO) in the spaces provided.
Enter the DO address and telephone number where indicated.