This document is a declaration for obtaining a limited Social Security card credential in the District of Columbia (DC). It includes certifications that an applicant has not been assigned a Social Security number, or if assigned, cannot establish legal presence in the US at the time of application, or if they are not eligible. The form also contains declarations regarding the truthfulness and accuracy of provided information. Violators face penalties under DC law, including fines up to $1,000 or 180 days imprisonment, or both. DC DMV-SSN-001 (Version 3/31/14). The form requires the applicant's full name and date of birth.
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