Form SSA-795: Statement of Claimant or Other Person
General-purpose signed statement used to give Social Security information or explanations about a claim, signed under penalty of perjury by the claimant or another person.
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Instructions for filling out Form SSA-795: Statement of Claimant or Other Person
This template is used for official filing and documentation. Below are detailed instructions for completing, requirement details, and submission rules.
Who needs to fill out this document?
This form is designed for use by legal entities, individuals, or authorized representatives in the following cases:
- Claimants explaining facts in their case.
- Family members, employers or witnesses providing information.
- Representatives submitting statements.
What you will need before starting
Before filling out the interactive form, prepare the following details and documents:
Step-by-step filling process
- Identify the claimant: Name and SSN.
- Write the statement: Facts relevant to the claim, as instructed by SSA.
- Sign: Under penalty of perjury.
- Submit: Send to the Social Security office requesting it.
Frequently Asked Questions (FAQ)
When is SSA-795 used?
When Social Security asks for a written statement, such as about living arrangements or relationships.
Can someone else write it?
Yes, a witness or other person can make a statement.
Is it legally binding?
It's signed under penalty of perjury, so false statements can have legal consequences.
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