Application for a Social Security Card - Asking for Replacement Card beyond allowable limits

SSA will insert the following revised Privacy Act Statement into the form as soon as possible:

Privacy Act Statement

Collection and Use of Personal Information

Sections 205(c) and 702 of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent us from issuing you a Social Security number (SSN) and card. We will use the information to provide and assign you an SSN and issue you a Social Security card. Additional information, and a full listing of all of our system of records notices, is available on our website at www.socialsecurity.gov/privacy.