SSA Retirement, Dependent & Survivors Forms

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Quickly access the forms to file an application for Social Security Disabled Widow(er)s, Disabled Surviving Divorced Spouses and Childhood Disability benefits.

When filing a disability claim on the Social Security account of a worker who is receiving Social Security disability or retirement benefits or on the account of a worker who has died, the base form that is used is the same as the application form for a non-disabled dependent or survivor. For disabled widows, widowers, and surviving divorced spouses, the form is the SSA-10. For disabled adult children (who became disabled before age twenty-two) the application for Childhood Disability Benefits is the SSA-4-BK.

Both these application forms, the SSA-10 and the SSA-4-BK, need to be supported with the same medical and vocational statements and authorization as a disabled worker’s application. These forms can be found in the Disability Application Forms section of this website. You will also find other applications and reporting forms for Social Security claimants who are not disabled.

Please click on a link below to open your desired form in a separate browser window. You can then download the form from directly to your computer.

SSA-1-BK Application for Retirement Insurance Benefits

SSA-2-BK Application for Wife’s or Husband’s Insurance Benefits

SSA-3 Marriage Certification

SSA-4-BK Application for Child’s Insurance Benefits

SSA-5-BK Application for Mother’s or Father’s Insurance Benefits
(for parent with child in care)

SSA-7-F6 Application for Parent’s Insurance Benefits
(for dependent parent)

SSA-8 Application for Lump-Sum Death Payment

SSA-10 Application for Widow’s or Widower’s Insurance Benefits

SSA-25 Certification of Election for Reduced Spouse’s Benefits

SSA-2519 Child Relationship Statement

SSA-4111 Certification of Election for Reduced Widow(er)’s/Surviving Divorced Spouse’s Benefits

SSA-1383 Advanced Notice of Termination of Child’s Benefits
(for continuation of benefits while age 18 and in school up to grade 12.

SSA-1945 Student Reporting Form
(to report change in student status or other terminating events)

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