There may be circumstances where the individual cannot go to SSA due to lack of transportation, physical or mental incapacity, etc. If this is the case, the CAO will contact SSA to explain the situation and coordinate suitable arrangements. SSA can complete the application by phone and/or mail. The PA 1564 is still required for verification that an application for an SSN was completed.
If an SSN is requested for individuals who are under age 18, or are age 18 or older and are physically or mentally incapable of signing the application, the following individuals may apply for an SSN on their behalf:
A parent (natural, adoptive, step).
A brother, sister, grandparent, aunt, or uncle.
A legal guardian, administrator of the individual’s estate, or representative payee.
State welfare agency (including state mental institution).
The CAO will refer an individual to SSA to apply for an SSN when:
The individual never had an SSN or cannot remember his SSN.
The individual is required to go to the SSA office concerning his SSN, such as a name change or evidence that a previously verified number is incorrect.
NOTE: The purpose of the SSA referral form is to refer individuals to SSA and to provide proof to the CAO that the individual went to SSA.
The individual has more than one SSN. SSA will determine the number which identifies the individual. The CAO will not enter an SSN on eCIS until SSA provides the correct number. The individual must provide verification from SSA that the problem is being corrected before the CAO will authorize benefits.
The individual’s SSN cannot be posted to eCIS and the CAO has determined that all demographic information is correct. See 950, Appendix A.
The individual’s SSN cannot be validated by SSA and the CAO has determined that all demographic information is correct. See Section 950.32, Validation.
Do not refer the individual to SSA if the following situations occur:
The individual reports having an SSN and remembers the number. Enter the number in eCIS and allow the validation system to determine if the number is correct.
The individual’s SSN has already been validated (confirmed by SSN verification code 6 or 7 appearing in eCIS), unless the CAO believes a validated number may be incorrect.
The CAO will complete the PA 1564 in duplicate when referring an individual to SSA. The CAO will give the individual the original and keep a copy in the case record until the individual returns the original copy completed and signed by SSA. The copy completed by SSA must be kept in the case record until the SSN is posted to eCIS.
The CAO will review the documentation information on the reverse side of the form with the individual and discuss the types of evidence of age, identity and US citizenship or alien status the individual must present to SSA. The CAO will assist the individual if necessary, to obtain the documents.
REMINDER: SSA will not indicate on the PA 1564 that the application for an SSN has been completed until all required verifications are presented.
The CAO Will enter information on the PA 1564 as follows:
Return Date – The date the individual is requested to return the form to the CAO.
Individual Name – The full name of the individual who must apply for an SSN or verify an SSN.
Individual’s SSN, if applicable – The SSN associated with the individual, if the individual has a number. If the individual has more than one number, enter all numbers. Leave blank if the individual does not have an SSN.
Welfare ID Number (NPN) – Enter the welfare ID number as follows:
1. The first two digits of the State BENDEX Code (39) are pre-entered. Leave the shaded space blank.
2. Enter the two digit county code.
3. Enter the two digit or alpha district code. If the CAO has no districts, enter two zeros.
4. Enter the seven digit record number. Proceed with zeros if the record number contains fewer than seven digits.
5. Enter the two digit line number assigned to the individual.
NOTE: Write zeros with a slash (Ø) to distinguish them from the letter O.
Example: 39 Ø2Ø11234567Ø1
To Apply for a Social Security Number – Check this block if the client does not have an SSN.
To Verify a Previously Assigned Social Security Number – Check this block if one of the following situations applies:
Individual says he was issued an SSN, but cannot remember the number.
Individual has more than one number.
NOTE: Enter all numbers provided by the individual in the block designated “Client’s SSN, if Applicable.”
Individual reports a name change from the name on the SSN card. Check this block if the correct name is on eCIS and the name on the SSN card is different.
The SSN cannot be posted to eCIS or validated by SSA because of a mismatch. Check the appropriate mismatch block and provide SSA with the correct information.
NOTE: These mismatches appear on the ENV 190-R01 report for enumeration or the ENV 290-R01 report for validation. See 950, Appendices A and C.
Other – Explain the reason the referral is being made.
To Be Completed by the Social Security Administration – This section will be completed by SSA. If the application cannot be processed, SSA will provide the individual with an explanation.
NOTE: Tell the individual to make certain that SSA completes and signs this section to verify his SSN or that he applied for an SSN.
County Assistance Office – Name and address of the CAO.
County Assistance Office Signature and Date – The signature of the CAO caseworker who is referring the individual to SSA and the date the referral form is completed by the CAO.
Telephone Number – The CAO caseworker’s phone number.
Reviewed July 17, 2018