Updated October 19, 2026. Quick answer: Form SSA-4-BK is the Application for Social Security Benefits, Child’s Insurance Benefits. A parent or guardian files it for children of a worker who is retired, disabled or deceased. A child can qualify under age 18, at 18 or 19 as a full-time student in grade 12 or lower, or at 18 or older with a disability that began before age 22. A child may get up to half of the worker’s full benefit, or 75% of a deceased worker’s benefit amount.
Quick reference
| Item | As printed on the form or in Social Security’s booklets |
|---|---|
| What the form is | Application for child’s insurance benefits on a worker’s record |
| Child qualifies | Under age 18 |
| Student | Age 18 to 19, elementary or secondary school (grade 12 or lower), full time |
| Disabled adult child | Age 18 or older, disability began before age 22 |
| Amount, worker alive | Up to half of the worker’s full benefit |
| Amount, worker deceased | 75% of the worker’s benefit amount |
| Family limit | Between 150% and 180% of the worker’s benefit |
| Pages | 9; Part 2 is only if the worker has died |
Who the form covers
The form opens by saying who is applying: “With this application, you are applying on behalf of the child or children listed in item 3 below for all insurance benefits for which they may be eligible”. If you are applying on your own behalf, you answer the questions about yourself.
Item 3 lists the children who qualify: those who are “Under age 18”, those “Age 18 to 19 and attending elementary or secondary school (grade 12 or lower) full-time” and those “Age 18 or older with a disability that began before age 22”. Natural children, adopted children, stepchildren and dependent grandchildren are all listed.
What a child receives
For a living worker, the retirement booklet says “Your child may get up to half of your full benefit.” The family limit applies: “This limit varies between 150% and 180% of your own benefit payment.”
For a deceased worker the survivors booklet sets the child’s share at “Child gets 75% of the worker’s benefit amount.” with the same overall family cap: “The limit varies between 150% and 180% of the deceased worker’s benefit amount.” When several children and a surviving spouse claim on one record, the cap, not each child’s 75%, can decide the check. Our page on Social Security for grandchildren covers when a grandchild qualifies.
The worker-alive and worker-deceased sections
The form splits by whether the worker is living. The instruction reads “Complete items 14 and 15 ONLY if the Worker is living.” and Part 2 reads “Complete items 17 through 24 only if the Worker is deceased.” Items 14 and 15 ask about adopted children and whether the children lived with the worker for the last 13 months. Part 2 asks for the worker’s date and place of death, railroad work, foreign Social Security credits and the worker’s earnings in the year of death and the year before.
Items 10 to 13 collect each child’s earnings for last year, this year and next year, and the exempt amount, unless you are applying only for a disabled adult child. After the award, the form tells you that “the law requires that a report of earnings be filed with SSA within 3 months and 15 days after the end of any taxable year in which the child earns more than the annual exempt amount.” It also notes that the child’s earnings information you give is your responsibility to get right.
Signing, sending and the receipt
The applicant signs in ink under penalty of perjury, adds a telephone number and gives the direct deposit details or chooses Direct Express. A mark (X) needs two witnesses. The form says “SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE.” Page 8 is a detachable receipt with a claim number to quote when you call, and page 9 lists what to report afterwards, such as a change of address, a student leaving full-time attendance, a child’s marriage, or a child leaving your care.
If the worker has died, the same form is used for survivors claims and our checklist on the first steps after a death lists the other calls to make. The detailed lump-sum claim is on Form SSA-8.
The edition read for this page is Form SSA-4-BK (05-2023) 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
- Dropping a child at 18. A full-time student in grade 12 or lower can qualify through age 19, and a disabled adult child whose disability began before age 22 can qualify at any age.
- Expecting each child to get the full 75% when several people claim on one record. The family limit of 150% to 180% applies.
- Filling in the worker-deceased pages for a living worker, or the reverse. The form says which items apply to which.
- Forgetting the child’s earnings report. It is due within 3 months and 15 days after the end of a taxable year in which the child earns more than the exempt amount.
Related: Social Security for grandchildren, Form SSA-5-BK, Form SSA-10, and Social Security and Medicare forms.
Sources
- Form SSA-4-BK (05-2023), Application for Social Security Benefits, Child’s Insurance Benefits: https://www.ssa.gov/forms/ssa-4-bk.pdf
- SSA Publication 05-10035 (2026), Retirement Benefits: https://www.ssa.gov/pubs/EN-05-10035.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.