Affidavit by Attending Physician to Prove Date of Birth of Child and Parentage to Social Security Administration in Order to Receive Benefits
About this form
The Affidavit by Attending Physician to Prove Date of Birth of Child and Parentage to Social Security Administration is a legal document used to verify the date of birth and parentage of a child for the purpose of obtaining benefits from the Social Security Administration (SSA). This affidavit serves as credible evidence of age, which is often required for applications related to retirement, spousal, child's, widow's, widower's, and parentâs benefits. Unlike a birth certificate, this form provides an alternative means of establishing the claimant's age and parentage directly from the attending physician, thereby facilitating access to necessary benefits.
Key components of this form
- Name and address of the affiant (attending physician).
- Physicianâs state of licensure and duration of practice.
- Childâs name and birth date along with place of birth.
- Residence address of the child.
- Names of both parents and how the physician knows them.
- Application details for the specific benefits being claimed.
When to use this document
This form should be used when applying for Social Security benefits that require proof of a child's date of birth and confirmation of parentage. Examples include applications for child disability benefits, retirement benefits, or spousal benefits where age and parentage must be established. It is particularly useful in situations where a birth certificate may not be available or when alternative proof is required by the SSA.
Intended users of this form
- Parents applying for Social Security benefits for their children.
- Attending physicians who have information about the child's birth and parentage.
- Legal guardians seeking to establish age and parentage on behalf of a child.
Instructions for completing this form
- Fill in your name and address as the affiant.
- Provide your state of licensure and duration of your medical practice.
- Enter the child's name, date of birth, and place of birth.
- Indicate the current address of the child.
- Name the child's parents and explain your knowledge of their identities.
- Complete any relevant details related to the application for the benefits being sought.
Notarization requirements for this form
Yes, this form must be notarized to be legally valid. The affidavit needs to be signed in the presence of a notary public to ensure authenticity and adherence to local legal requirements. US Legal Forms offers integrated online notarization services, which are available 24/7 through secure video calls, ensuring your affidavit can be notarized easily and efficiently without the need for travel.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Typical mistakes to avoid
- Forgetting to include the childâs birthdate or place of birth.
- Omitting the affiant's signature or failing to have it notarized.
- Not providing detailed explanations of how the physician knows the parents.
- Failing to attach this affidavit to the official application for benefits.
Benefits of completing this form online
- Convenience of accessing the form anytime and from anywhere.
- Editable templates allow for easy customization to fit specific needs.
- Access to legal forms drafted by licensed attorneys, ensuring reliability.
Key takeaways
- The affidavit by attending physician is essential for claiming Social Security benefits based on age and parentage.
- It requires input from an attending physician, ensuring credibility in the information provided.
- Always ensure the form is completed accurately and notarized to avoid delays in benefit processing.
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FAQ
You can apply for benefits by calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or by visiting your local Social Security office.
You can apply for benefits by calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or by visiting your local Social Security office.
Birth certificate or other proof of birth; Proof of U.S. citizenship or lawful alien status if you were not born in the United States; U.S. military discharge paper(s) if you had military service before 1968; W-2 forms(s) and/or self-employment tax returns for last year;
You can apply for benefits by calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or by visiting your local Social Security office. An appointment is not required, but if you call ahead and schedule one, it may reduce the time you spend waiting to apply.
Your Social Security card or a record of your number. Your original birth certificate, a copy certified by the issuing agency, or other proof of your age. If you were not born in the U.S., proof of U.S. citizenship or lawful alien status.
How do I report earnings? You may call us at 1-800-772-1213. Or you may call, visit, or write your local Social Security office. Social Security also offers a toll-free automated wage reporting telephone system and a mobile wage reporting application.
How do I apply? At the hospital: When you give information for your baby's birth certificate, you'll be asked whether you want to apply for a Social Security number for your baby. If you say yes, you need to provide both parents' Social Security numbers if you can.
Within a family, a child can receive up to half of the parent's full retirement or disability benefit. If a child receives survivors benefits, they can get up to 75 percent of the deceased parent's basic Social Security benefit.
Name and address. Social security claim number. Name of child beneficiary to whom this statement applies. Date child attains age 18. Current school attendance. Last school year. Signature of student. Certification by School Official.
