Child Relationship Statement

Form SSA-2519 (08-2019) Discontinue Prior Editions Social Security AdministrationPage 1 of 3 OMB No. 0960-0116 Privacy Act Statement Collection and Use of Personal Information Section 216(h)(3) of the Social Security Act, as amended, allows us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent us from making an accurate and timely decision regarding Social Security benefits. We will use the information to determine eligibility for benefits. We may also share your information for the following purposes, called routine uses: To third party contacts, where necessary, to establish or verify information provided by representative payees or payee applicants; and To contractors and other Federal agencies, as necessary, for the pur

Paperwork Reduction Act Statement PRINT WAGE EARNER'S NAME WAGE EARNER'S SOCIAL SECURITY NUMBER. List below all children of the wager earner (hereafter referred to as the worker) for whom you are requesting benefits. NAME OF CHILD OR CHILDREN

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