SSA-795 2020 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 Name of Person Making Statement If other than above wage earner self-employed person or SSI claimant Relationship to Wage Earner Self-Employed Person or SSI Claimant Understanding that this statement is for the use of the Social Security Administration I hereby certify that - Form SSA-795 09-2015 ef 09-2015 Destroy Prior Editions I...

How to fill out SSA-795

How to fill out SSA-795

1. Obtain the SSA-795 form from the Social Security Administration website or your local office.
2. Fill in the personal information section, including name, Social Security number, and address.
3. Provide relevant details about the reason for your statement or request.
4. Clearly explain the circumstances or situation that necessitates the use of the SSA-795.
5. Review the completed form for accuracy and completeness.
6. Sign and date the form before submission.
7. Submit the form through the appropriate channel, either online, by mail, or in-person at a local Social Security office.

Who needs SSA-795?

1. Individuals who need to provide a statement regarding their inability to provide specific information or documentation as requested by the Social Security Administration.
2. People applying for Social Security benefits who must report special circumstances.
3. Beneficiaries who need to clarify issues related to their benefits or claims.

• 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

What is an SSI determination letter?

The benefit verification letter, sometimes called a "budget letter," a "benefits letter," a "proof of income letter," or a "proof of award letter,” serves as proof that you either: Get Social Security benefits, Supplemental Security Income (SSI), or Medicare.

What is the SSA benefit statement form?

An SSA-1099 is a tax form we mail each year in January to people who receive Social Security benefits. It shows the total amount of benefits you received from us in the previous year so you know how much Social Security income to report to the Internal Revenue Service on your tax return.

What is a determination letter from Social Security?

It may be referred to as a "proof of income letter" or "benefit letter" and is personalized based on the status of your Social Security benefits, Supplemental Security Income, and Medicare coverage.

What is a determination letter from disability?

A Social Security Disability award letter, or notice of award, is the formal letter received from the Social Security Administration's (SSA) Disability Determination Services (DDS) office that informs you that you are eligible to receive disability benefits.

What is the SSA-795 form for?

If you can't find the form you need, or you need help completing a form, please call us at 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office and we will help you.Forms. NumberTitleSSA-789-U4Request for Reconsideration - Disability CessationSSA-795Statement of Claimant or Other Persons174 more rows

What is the SSA form for deceased?

Form SSA-10 | Information You Need to Apply for Widow's, Widower's or Surviving Divorced Spouse's Benefits. You can apply for benefits by calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office.

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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 claim for Social Security benefits, particularly when the claim involves a change in circumstances or needs additional information.

Who is required to file SSA-795?

Individuals who need to report changes in their circumstances that may affect their Social Security benefits or who are providing additional information to the Social Security Administration are typically required to file SSA-795.

How to fill out SSA-795?

To fill out SSA-795, individuals should provide their personal information, details of the changes they are reporting, and any relevant supporting documentation. The form must be completed accurately and signed before submission.

What is the purpose of SSA-795?

The purpose of SSA-795 is to ensure that the Social Security Administration has up-to-date information regarding an individual's qualification for benefits, facilitating accurate assessment of eligibility and benefit amounts.

What information must be reported on SSA-795?

Information that must be reported on SSA-795 includes personal identification details, the nature of the change in circumstances, dates of events relating to the change, and any relevant income or financial information.