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 or other documents are 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.
The County Assistance Office (CAO) (including state hospitals).
The CAO will refer an individual to SSA to apply for an SSN when:
The individual never had an SSN or cannot remember their SSN.
The individual is required to go to the SSA office concerning their 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.
Non-citizens:
who have never applied for an SSN will be assisted by the CAO in applying for an SSN. The CAO will complete the PA 1564 with the individual and assist them with completing the SS-5 Application for a Social Security Card. The SS-5 can be found on-line, printed, and provided to the non-citizen.
that did apply for an SSN with the help of another agency and are waiting for SSA to assign a number may use alternate methods that demonstrate they have cooperated in applying for an SSN.
that applied with the help of another agency and were assigned a number but do not remember it and are unable to document it, may also use alternate methods that demonstrate they have cooperated in applying for an SSN.
Example: When USCIS authorizes employment, that process includes applying for an SSN and results in USCIS issuing the I-766 Employment Authorization Document (EAD) card.
that are not Authorized for Work require an SSN to be eligible for ongoing TANF and SNAP. Non-citizens that are not Authorized for Work are not required to provide or apply for an SSN for MA, LTC, and CHIP as a condition of eligibility; however, the CAO will still assist them in applying for one.
may have a letter from SSA stating the individual is ineligible for an SSN due to not being work authorized or the Systematic Alien Verification for Entitlements (SAVE) verification indicates they are not authorized to work. The CAO must assist the individual in applying for the restricted non-work authorization SSN. The CAO will provide the individual with the new PA 1564 to request the restricted non-work authorization SSN and refer them back to SSA.
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 with the ink signature and scan 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 evidence 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 non-citizen 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.
Welfare ID Number (NPN) – Enter the NPN 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
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.
To Apply for a Social Security Number – Check this block if the client does not have an SSN and is a U.S. citizen or Lawful Permanent Resident.
To Apply for a Restricted Social Security Number
Check this block if the client does not have an SSN and is a lawfully present non-citizen
Mark the assistance program the individual is eligible to receive with proper enumeration.
Mark the MA program box for SBP and LTC.
Provide the Systematic Alien Verification for Entitlements (SAVE) number or the Passport number.
To Verify a Previously Assigned Social Security Number – Check this block if one of the following situations applies:
Individual says they were 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 "SSN”
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 as Workload Dashboard Alert SSN 020 – SSN Unverified by SSA Demographic Review Required.
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.
County Assistance Office – Name and address of the CAO.
County Assistance Office Signature and Date – The signature, in ink, of a CAO representative (caseworker, supervisor or manager) and the date the referral form is completed by the CAO. The signature cannot be electronic or a photocopy. SSA must receive the PA 1564 with the original ink signature of an agency representative.
Telephone Number – A CAO representative (caseworker, supervisor, or manager) must enter a phone number.
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 their SSN or that they applied for an SSN.
A case narrative must be entered stating the original PA 1564 was provided to the applicant/recipient. A second narrative must be entered about the outcome of the referral to SSA for an SSN.
Updated September 15, 2025, replacing July 17, 2018