Form SSA-7-F6 Application for Parent's Insurance Benefits

Form SSA-7-F6 Instructions

Add the following information to your Parent Insurance Benefits Application:

1. State the name, gender, and social security number of the deceased worker.
2. Write down your name, social security number, and name at birth if it is different from your current name.
3. Indicate whether you were receiving more at least half of your financial support from the deceased and whether you have ever filed evidence of this support to the SSA.
4. Record the deceased's dates of birth and death and place of death. State whether they ever filed for Social Security benefits, Medicare insurance, or Supplemental Security Income.
5. If the deceased was unable to work because of a disability at the time of death, answer "yes" and indicate the date this disability began.
6. If the deceased was on active military or naval duty between 1939 and 1968, check the appropriate box and enter the dates of service.
7. If the death occurred within the last two years, enter the amount of money the worker earned during the year of death and the previous year. Specify the years from 1978 in which the deceased did not have Social Security covered income.
8. State your date and place of birth. Record the type of your birth records. If you have married since the death of the worker, describe your marriage, and add the spouse's social security number.
9. Indicate whether you have ever filed for any Social Security benefits.
10. If you were in the active military or naval service between 1939 and 1968 and you, your current spouse, or the deceased worker worked in the railroad industry for five years or more, answer "yes".
11. If you have Social Security credits in another country, name this country.
12. Record your earnings last year and expected income this year and next year.
13. If you are within three months of 65 years old or older, you can enroll in Medicare Part B by checking the appropriate box.
14. Sign and date the form. Provide your contact details and the address for the direct deposit payment.

SSA-5-BK Related Forms

• Form SSA-5-BK, Application for Mother's or Father's Insurance Benefits, is a related form that allows the deceased wage-earner's spouse to claim benefits if this spouse takes care of the deceased's children;
• Form SSA-5-BK-SP, Application for Mother's or Father's Insurance Benefits (Spanish), is completed by deceased workers' spouses who prefer to present a Spanish version of the application;
• Form SSA-5-INST, Reporting Responsibilities for Mother's or Father's Insurance Benefits, describes changes in circumstances that must be reported to the SSA because they may lead to the modification of benefits;
• Form SSA-7-F6-SP, Application for Parent's Insurance Benefits (Spanish), is similarly used to apply for insurance benefits by parents of insured workers who died if they choose to file a claim in Spanish.