SSA-795 2009 free printable template

Form Approved OMB No. 0960-0045 SOCIAL SECURITY ADMINISTRATION STATEMENT OF CLAIMANT OR OTHER PERSON NAME OF WAGE EARNER SELF-EMPLOYED PERSON OR SSI CLAIMANT SOCIAL SECURITY NUMBER NAME OF PERSON MAKING STATEMENT If other than above wage earner self-employed person or SSI claimant - RELATIONSHIP TO WAGE EARNER SELFEMPLOYED PERSON OR SSI CLAIMANT Understanding that this statement is for the use of the Social Security Administration I hereby certify that - Form SSA-795 6-2009 ef 06-2009 Destroy...

How to fill out ssa 795 2009 form

How to fill out SSA-795

1. Obtain a copy of the SSA-795 form from the Social Security Administration's website or local office.
2. Fill in your name, Social Security number, and contact information at the top of the form.
3. Write a clear statement explaining the reason for the SSA-795, detailing any changes in circumstances or information.
4. Provide any relevant dates that pertain to your statement.
5. Sign and date the form at the bottom to certify that your information is correct.
6. Submit the completed form to the local Social Security office, or follow the instructions for electronic submission if available.

Who needs SSA-795?

1. Individuals who need to report changes or provide statements regarding their Social Security benefits or claims.
2. Those who are applying for Social Security benefits and have specific situations that require detailed explanations.
3. Anyone who has been asked by the Social Security Administration to provide additional information regarding their claim.

• Who needs an SSA-795 form?
• Why should I use the SSA-795?
• Is the SSA-795 accompanied by other forms?
• Does the SSA-795 have a validity period?
• • What information should be provided in the SSA-795 form?
  • Where do I send the SSA-795 form?

Who needs an SSA-795 form?

If you claim supplemental security income (SSI) benefits, you have to fill out the Application for Supplemental Security Income form that suits your case. While completing the form you (or the person who completes the form on your behalf) may need additional space for remarks and statements. In this case, you have to use the SSA-796 form — Statement of a Claimant or Other Person.

Why should I use the SSA-795?

This form is used whenever there is a need to provide a signed statement. The claimant or other person may need to make a statement on the following occasions: on legal and equitable adoption, about divorce and termination of prior marriage, if there is a conflict in the evidence, etc. The form will help the Social Security Administration make the right decision on the individual’s case.

Is the SSA-795 accompanied by other forms?

The statement is always accompanied by other forms, as it serves as just a part (evidence) of the certain claim or application.

Does the SSA-795 have a validity period?

The statement is valid only with the form it supports.

What information should be provided in the SSA-795 form?

The filler must type the name of the wage earner, self-employed person or claimant, and his/her Social Security Number. If the claimant and person who is making the statement are different people, the filler adds his/her personal information as well. Then there is a space for the statement text.

The person who is making the statement must sign and date the form and add the appropriate phone number and mailing address. If a witness is required, he should also sign the form and type his addresses.

Where do I send the SSA-795 form?

The statement is forwarded to the local Social Security Office

People Also Ask about

Can I check my Social Security account online?

You can get your Social Security Statement (Statement) online by using your personal my Social Security account. Your online Statement gives you secure and convenient access to estimates for retirement, disability, and survivors benefits you and your family may be eligible for.

Can you submit Social Security forms online?

Today, you can apply for retirement, disability, and Medicare benefits online, check the status of an application or appeal, request a replacement Social Security card (in most areas), print a benefit verification letter, and more – from anywhere and from any of your devices!

How do I submit documents to Social Security?

You can upload documents by using the Send Response for Individual Case link on the Electronic Records Express Home page. The upload function is also available while accessing a claimant's electronic folder through the Access Claimant's Electronic Folder link.

How do I submit a form to Social Security?

You can upload documents by using the Send Response for Individual Case link on the Electronic Records Express Home page. The upload function is also available while accessing a claimant's electronic folder through the Access Claimant's Electronic Folder link.

Can you fill out a Social Security form online?

Adults filing online now can use a click-and-sign process, while those filing by telephone or in person can use our attestation process to sign and submit their SSA-827.

Can I fill out my Social Security application online?

Today, you can apply for retirement, disability, and Medicare benefits online, check the status of an application or appeal, request a replacement Social Security card (in most areas), print a benefit verification letter, and more – from anywhere and from any of your devices!

How do I complete my Social Security application?

You can apply: Online; or. By calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office. Call ahead to make an appointment. If you do not live in the U.S. or one of its territories, you can also contact your nearest U.S.

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What is SSA-795?

SSA-795 is a form used by the Social Security Administration to collect information about an individual's medical condition and their ability to work.

Who is required to file SSA-795?

Individuals applying for Social Security disability benefits, or those who are already receiving benefits and need to report changes in their medical condition.

How to fill out SSA-795?

To fill out SSA-795, users should provide accurate details regarding their medical condition, treatment history, and how their condition affects their daily activities and ability to work.

What is the purpose of SSA-795?

The purpose of SSA-795 is to assess an individual’s eligibility for Social Security disability benefits by gathering comprehensive information about their health and functional limitations.

What information must be reported on SSA-795?

The form requires reporting of details such as medical diagnoses, treatment history, doctor’s information, and descriptions of how the condition impacts daily life and work ability.