Updated October 19, 2026. Quick answer: Form SSA-5-BK is the Application for Mother’s or Father’s Insurance Benefits. A surviving spouse or surviving divorced spouse of a deceased worker uses it while caring for the worker’s child who is under age 16 or disabled. The booklet puts the survivor at 75% of the worker’s benefit amount while the child is younger than 16. The benefit is not payable if the only child in your care is 16 or older and not disabled.
Quick reference
| Item | As printed on the form or in Social Security’s survivors booklet |
|---|---|
| What the form is | Application for survivor benefits while caring for a deceased worker’s child |
| Child must be | Under age 16, or disabled with disability before age 22 |
| Rate | 75% of the worker’s benefit amount (surviving spouse with a child younger than 16) |
| Not payable when | The only child in your care is age 16 or over and not disabled |
| Lump-sum death payment | $255, apply within 2 years of the date of death |
| Other marriages to list | Any that lasted at least 10 years or ended in the spouse’s death |
| Family limit | Between 150% and 180% of the deceased worker’s benefit amount |
| Pages | 7 |
Who uses it, and who does not
The form’s rule is stated before question 5: “You may receive a mother’s or a father’s benefit for any month in which you have in your care the deceased’s child or dependent grandchild who is entitled to a child’s benefit if the child is:” Under age 16, or disabled (age 16 or over with the disability starting before age 22).
The cutoff is blunt: “Mother’s or father’s benefits are not payable if the only child in your care is a child age 16 or over who is not disabled.” For a surviving divorced parent, “the child must be your son, daughter, or legally adopted child who is entitled to child’s benefits on the deceased’s earnings record.”
What the benefit pays
The survivors booklet gives the rate: “Surviving spouse, any age, with a child younger than age 16, gets 75% of the worker’s benefit amount.” The family limit still applies: “The limit varies between 150% and 180% of the deceased worker’s benefit amount.”
The booklet also states the one-time payment: “If you’ve worked long enough, we make a one-time payment of $255 when you die.” “Survivors must apply for this payment within 2 years of the date of your death.” The form says the answers “will ordinarily be sufficient for a determination on the Lump-Sum Death Payment as well.” The separate lump-sum application is Form SSA-8, and the money is covered at the Social Security death benefit.
The marriage questions
Questions 10 and 11 are where most of the paperwork sits. Item 10 asks about your marriage to the deceased, any later marriage, and other marriages. For other marriages the form says to include those that “lasted at least 10 years or ended due to death of the spouse”. If you divorced and remarried the same person within the year after the divorce year, the form counts the combined marriage if it totals 10 years or more.
Item 11 mirrors this for the deceased’s own other marriages. Item 12 asks whether you and the deceased lived together at death, and a surviving divorced applicant skips it. Our pages on remarriage rules and the survivor benefit calculator cover how those answers change the monthly figure.
Work, other benefits and how to send it
Items 13 to 15 ask for your earnings last year, this year and next year, in months at or under the monthly limit, which the form tells you to read from its instructions. Item 6 asks whether you have been unable to work because of illness, injury or a condition, item 7 asks about five years of railroad work and item 8 asks about Social Security credits in another country.
This application is treated as more than one claim. The form states that it “may also be considered an application for survivors benefits under the Railroad Retirement Act” and for Veterans Administration payments. Details of signing, witnesses and the direct deposit are on the later pages. Take it to a Social Security office or call 1-800-772-1213.
The edition read for this page is Form SSA-5-BK (05-2025) as the agency served it on 2026-10-19. Check the edition printed on the copy you use, because a later edition can change the questions, the mailing instructions and the evidence asked for.
Common mistakes
- Stopping when the youngest child turns 16. The benefit is payable while a child under 16, or a disabled child, is in your care; if the only child is 16 or older and not disabled it is not.
- Leaving out an earlier marriage that lasted 10 years or ended in a spouse’s death. Item 10 asks for those.
- Treating the 75% as a guaranteed check. The family limit of 150% to 180% can reduce it when several people claim on one record.
- Filing late for the one-time payment. Survivors must apply within 2 years of the date of death.
Related: Form SSA-4-BK, Form SSA-10, Form SSA-8, and Social Security and Medicare forms.
Sources
- Form SSA-5-BK (05-2025), Application for Mother’s or Father’s Insurance Benefits: https://www.ssa.gov/forms/ssa-5-bk.pdf
- SSA Publication 05-10084 (April 2026), Survivors Benefits: https://www.ssa.gov/pubs/EN-05-10084.pdf
Read from the Social Security Administration and Centers for Medicare and Medicaid Services documents linked above on October 19, 2026. General information, not legal or benefits advice. Your own facts decide the outcome, and Social Security at 1-800-772-1213 is the right place to confirm anything consequential.