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This version of the form is not currently in use and is provided for reference only. Download this version of
Form SSA-4-BK
for the current year.
Form SSA-4-BK Application for Child's Insurance Benefits
What Is Form SSA-4-BK?
Form SSA-4-BK, Application for Child's Insurance Benefits , is a form that is used to apply for Child's Insurance Benefits on behalf of children.
Alternate Name:
- Child Insurance Benefits Application.
This form was released by the Social Security Administration (SSA) and the latest version was issued on January 1, 2017 . A fillable Child Insurance Benefits Application is available for download below.
A child is eligible to get these benefits if they have:
- A disabled or retired parent, entitled to Social Security benefits; or
- A deceased parent who has died after paying enough Social Security taxes.
Child Insurance Benefits can be applied for on behalf of the applicant's natural children, their stepchild, grandchild, step-grandchild, and adopted child. The SSA-4-BK Form can be completed by a parent of a child or on behalf of a deceased parent.
Form SSA-4-BK Instructions
To qualify for Child's Insurance Benefits a child should be unmarried and meet the following conditions:
- Be younger than 18;
- Be 18-19 years old and a full-time student (no higher than grade 12); or
- Be 18 or older and disabled. Their disability, in this case, must have begun before age 22.
Form SSA-4-BK instructions are as follows:
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1 - 2. Enter full names and Social Security numbers of the SSA worker and the eligible applicant.
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Part 1 - Information about the worker's children:
- 3 - 5. Provide information about the children who are eligible for Benefits;
- 6 - 7. Indicate if you are the natural or adoptive parent of the indicated children, provide information about the presence of any other adoptive parents;
- 8. Indicate the children are not living with them now;
- 9. Indicate if any child in Item 3 has ever been married;
- 10. Provide information about anyone who has ever filed for Benefits on behalf of these children;
- 11 - 13. Enter the amount of each child's current and expected earnings over the exempt amount for this year, last year and next year;
- 14. Indicate the name of a child who uses a fiscal year (one that does not end on December 31);
- 15. Provide information about any children in Item 3 adopted by the worker;
- 16. Indicate any child who did not live with them during the last 13 months;
- 17. Respond regarding filing for Supplemental Security Income.
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Part 2 - Information about the deceased. Complete items 18 through 26 regarding the deceased worker only.
- 18 - 24. Provide information about this person;
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- Indicate the earnings of the deceased in the year of death and the year before death;
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- If there are any earnings of the deceased worker that are not yet on their earning records, indicate it in this Item;
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- Indicate if the worker has ever filed for Social Security benefits;
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- Note if the person was unable to work because of a disabling condition;
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- Provide information about any children of the deceased not living with them at the time of death.
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Sign the form, enter your full name and phone number.
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Provide Direct Deposit Payment information.
Looking to learn more? Check out these related forms and templates:
Download Form SSA-4-BK Application for Child's Insurance Benefits
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