The Social Security Administration will allow you to replace a card up to 3 times every year, since this is one of the most common instances.
Please provide the applicant gender.
Enter the applicant's first name, as you want it to appear on the Social Security Card.
Enter the applicant's middle name, as you want it to appear on the Social Security Card.
Enter the applicant's last name, as you want it to appear on the Social Security Card.
Please enter the applicant's first name at birth.
Please enter the applicant's middle name at birth.
Please enter the applicant's last name at birth.
Have you ever gone by any other name or alias?
Please provide the applicant's alias first name.
Please provide the applicant's alias middle name.
Please provide the applicant's alias last name.
Please select the country where the applicant was born.
Please select the state where the applicant was born.
Please select the city where the applicant was born.
Please select the applicant's date of birth.
Please enter the applicant's mother's first name.
Please enter the applicant's mother's middle name.
Please enter the applicant's mother's last name (her maiden name).
(If Deceased answer No)
Applicant's mother Social Security Number.
Please enter the applicant's father's first name.
Please enter the applicant's father's middle name.
Please enter the applicant's father's last name.
Applicant's father Social Security Number.
Enter the street address you would like the social security card mailed to. (Please do not abbreviate)
Please enter the zip code you would like the social security card mailed to.
Please enter city of the address you would like the social security card mailed to.
Please select the state of the address you would like the social security card mailed to.
Please specify your relationship with the applicant.
Please enter the signer's relationship to the applicant.
Please provide your daytime phone number.
Please provide your email address.
Please Re-enter your email address.