Application for a Social Security Card - Age 12 or older, additional questions

Appendix C: SSNAP Screen Designs
Main Menu ...................................................................................................................................... 2
Applicant Info – Select Applicant................................................................................................... 3
Numberholder Information ............................................................................................................. 4
Numberholder Address ................................................................................................................... 5
U.S. is Default Selection ......................................................................................................... 5
Foreign Address Selected ....................................................................................................... 5
Military Address Selected ....................................................................................................... 5
12 or Older Interview Questions ..................................................................................................... 6
U.S. Citizen 12 or Older Interview Questions ................................................................................ 6
Non U.S. Citizen 12 or Older Interview Questions ........................................................................ 6
Additional Information ................................................................................................................... 7
Verify and Sign ............................................................................................................................... 8
Voluntary Race and Ethnicity Identification .................................................................................. 9

Updated Appendix C: SSNAP Screen DesignsPage 1 of 9 – OMB
April 12, 2011

Main Menu

Options in the left menu will depend on the user’s profile.

This is an example of selecting Retrieve Application from the Main Menu and entering data for a
person who has never applied for a SSN. The user is then given the opportunity to create a new
application.

Updated Appendix C: SSNAP Screen DesignsPage 2 of 9 – OMB
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Applicant Info – Select Applicant

The user is able to select the language of the attestation that is to be presented to the applicant.
The corresponding attestation is presented on the screen. The US Mailing Zip Code is requested
to ensure that the applicant is in the proper jurisdiction to best be served. SSA has Card Centers
in major cities with their sole function to issue original and replacement SSNs.

This is the dropdown menu with the possible choices of a proper applicant.

Updated Appendix C: SSNAP Screen DesignsPage 3 of 9 – OMB
April 12, 2011

Numberholder Information

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Numberholder Address
U.S. is Default Selection

Foreign Address Selected

Military Address Selected

Updated Appendix C: SSNAP Screen DesignsPage 5 of 9 – OMB
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12 or Older Interview Questions
U.S. Citizen 12 or Older Interview Questions

Answers in this box to propagate to
the printed application

Non U.S. Citizen 12 or Older Interview Questions

Answers in this box to propagate to
the printed application

Updated Appendix C: SSNAP Screen DesignsPage 6 of 9 – OMB
April 12, 2011

Additional Information

Updated Appendix C: SSNAP Screen DesignsPage 7 of 9 – OMB
April 12, 2011

Verify and Sign

Updated Appendix C: SSNAP Screen DesignsPage 8 of 9 – OMB
April 12, 2011

Voluntary Race and Ethnicity Identification

Updated Appendix C: SSNAP Screen DesignsPage 9 of 9 – OMB
April 12, 2011