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Form SSA 2 Information You Need to Apply for Social Security
Application entitled "APPLICATION
FOR RETIREMENT INSURANCE BENEFITS", you need complete only the circled
items. All other claimants must complete the entire form.
1. (a) PRINT Name of Wage Earner or SelfEmployed Person
(Herein referred to as the "Worker")
FIRST NAME, MIDDLE INITIAL, LAST NAME
(b) Enter Worker's Social Security Number
Female
Male
2. Check (X) whether you are
3.
FIRST NAME, MIDDLE INITIAL, LAST NAME
(a) PRINT your name
(b) Enter your Social Security Number
Answer question 4...
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