950.4 Referral to the Social Security Administration

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:

 

The CAO will refer an individual to SSA to apply for an SSN when:

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.

Do not refer the individual to SSA if the following situations occur:

950.41 Preparation of the Referral to the Social Security Administration (PA 1564)

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:

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

NOTE: Enter all numbers provided by the individual in the block designated “Client’s SSN, if Applicable.”

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.

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.

Reviewed July 17, 2018