TN 43 (12-23)

RS 00203.070 Documenting the Application for Child’s Insurance Benefits, Form SSA-4-BK

A. Procedure for documenting dependency

NOTE: The child must meet the dependency requirement per GN 00306.002C.

  • Include under “Remarks” on the application or the RMKS screen in Modernized Claim System (MCS), any additional information needed to show whether dependency existed at one of the specified times (e.g., “Child living with parent at the time parent became entitled to Disability Insurance Benefit (DIB),” or “Step relationship not in existence at the beginning of the insured person's period of disability.”)

  • If a Statement Regarding Contributions, Form SSA-783, is required, secure the necessary information for the period pertinent to the dependency requirement.

B. Procedure item-by-item for the paper SSA-4-BK application

1. Item 3

Block Procedure

Name/sex of child

  • Check against proof of age and relationship submitted for the child.

Student, disabled

  • If a block is checked and the child is over 17 1/2 years of age, the file must reflect that there is development for student or CDB.

  • In the rare case where the claimant checked both blocks for the same child, it may be easier to entitle the child to student benefits while completing the CDB development. However, in any case, do CDB development because it is to the child's advantage for Medicare purposes to be entitled as a CDB even for those months in which student benefits might be payable. For information on student and CDB development, see RS 00203.090.


  • Note that, as development proceeds, the actual relationship of the child to the NH might be different from alleged.

  • When “other” block is checked, take particular care to ensure the applicant provides proper identification and completes dependency development prior to an award or disallowance.

2. Item 4

The date the number holder (NH) married the natural parent is important because the child cannot be the NH's stepchild if conceived and born to one of the parties after the marriage (unless the Hutcheson v. Califano acquiescence ruling in GN 00306.290 applies).

3. Item 5

To obtain the documentation required to develop a representative payee, see GN 00502.001.

4. Item 7

The purposes of this item are to:

  • determine if the child must meet a dependency test because of adoption by someone other than the NH;

  • identify claims where the child is adopted by the NHs surviving spouse; and

  • determine whether someone other than the NH should be the payee.

5. Item 8

The purposes of this item are to:

  • help determine where the child is living for representative payee payment situations;

  • relate to a “living-with” dependency requirement, if applicable;

  • help determine who has or had custody of the child for determining contributions or one-half support; and

  • corroborate child-in-care information on an Application for Benefits. Use either Form SSA-2 (Application for Wife or Husband Insurance Benefits), Form SSA-5-BK (Application for Mother’s and Father’s Insurance Benefits) or the electronic versions of the forms.

6. Item 9

If a disabled child, age 18 or over, is married and the application is for months before the marriage, find out whether the marriage was to a Social Security (SS) beneficiary.

If the marriage was... Then show in “Remarks” or on an RC the...

to an SS beneficiary

  • date of marriage,

  • name of spouse, and

  • name and SSN of NH whose ER provides the spouse's benefits.

not to an SS beneficiary

  • date of the marriage, and

  • marriage was not to an SS beneficiary.

NOTE: For termination of benefits due to marriage, see RS 00203.035A.3.

7. Item 15

For a child adopted after the NH’s entitlement, dependency development may be required. For information on adoptions, see GN 00306.210.

8. Item 16

The purposes of this item are to:

  • determine whether the "living-with" requirement is met for all possible months, when applicable;

  • Determine custody, where applicable; and

  • Indicate the need for a representative payee other than the NH.

C. Reference

To Link to this section - Use this URL:
RS 00203.070 - Documenting the Application for Child’s Insurance Benefits, Form SSA-4-BK - 07/09/2021
Batch run: 12/27/2023