SSA Form SSA-795

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SSA Form SSA-795

The Social Security Administration (SSA) seems to have the necessary form for any occasion. For instance, in certain situations when none of the authorized forms apply to the clause matter, the SSA asks the applicants to complete Form 795. This document is also called the Statement of Claimant or Other Person.

When SSA-795 is Used

This statement is completed by the claimant, applicant, or other people who can provide SSA with the required data. Typically, they will need you to provide all the related information concerning services provided by the SSI or Social Security benefits.

Thus, the SSA will require you to fill out exhaustive information which may relate to:

  • Benefit entitlements;
  • Current benefits;
  • Statements on legal and equitable adoption;
  • Fraud investigations;
  • Questions related to the program;
  • Statements about divorce and termination of a prior marriage
  • Other related issues.

Who Usually Needs to Fill Out This Form?

Most often, the Claimant is asked to fill out the form for their specific needs and matters only if they already are receiving benefits from programs sponsored by SSI or Social Security services. But in addition, the Administration can also appeal to friends, relatives, colleagues, employers of this person using this particular form.

Why Are There No Questions in the Form?

This document primarily consists of a set of blank lines for filling in the applicant’s contact information, a large empty space in the main body to set out the essence of your issue, and a clause on penalties for submitting any incorrect or otherwise invalid information.

The information provided by the form filler may vary. Therefore, the Administration allows you to enter it in an empty field and not fill in items with questions. That allows the placeholder to provide any additional information and removes the frames for the type of this information.

Also, some information can be collected in a personal interview or by phone. But the option of filling out the form is the most common.


Under Section 205 (a) of the Social Security Act, SSA may collect additional evidence to determine a citizen’s eligibility.

Per 20 CFR 404.702 and 416.570 of the Code of Federal Regulations, individuals use this document to make claims related to benefits.

Tips for Making a Statement

Before giving any statement, you need to understand what kind of information you can provide. It can be:

  • Facts
  • Opinions

The statement of facts should not raise questions. Facts are accurate information provided by a person with irrefutable knowledge, while opinions can be questioned and depend on the angle of consideration of the issue. They are just beliefs that need to be tested.

For instance, you might assume that the claimant and their partner are married if you hear them refer to each other as husband and wife (this is an opinion). But if you were present at their marriage ceremony and saw the certificate in person, is it considered to be a fact.

Ideally, your application should meet the following requirements:

  • Be reliable;
  • Have no inconsistencies;
  • Be clear and precise;
  • Have no bias;
  • Reflect all the facts that you know;
  • Be based on information received directly and not on rumors, speculation, and opinions.

Other SSA Forms

You will discover even more fillable SSA forms accessible with our editor. Down below, we selected a number of the more popular forms included in this category. Moreover, do not forget that you are able to upload, fill out, and edit any PDF at FormsPal.

How to Fill Out This Form

To fill out the document, we recommend you use our form-building software, as well as use our illustrated instructions below.

Identify the Claimant

You must indicate the name and SSN of the person affected by this document and whose case is being considered. It can be either yourself or another person.

step 1 identify the claimant filling out ssa form ssa 795

Identify Yourself

If you are filling out the document not concerning yourself, then write in these lines your name, as well as the degree of your relationship with the Claimant (relative, spouse, friend, neighbor, colleague, and so on).

step 2 identify yourself filling out ssa form ssa 795

Draft the Statement

At this point, you need to give the statement itself. We recommend that you refer to the advice we have provided above for a successful application. Remember to keep it short and clear. It is recommended to abandon evaluative characteristics and to state only the facts.

step 3 draft the statement filling out ssa form ssa 795

Provide the Signature

With your signature, you certify your testimony and declare that all your testimony was given honestly. Otherwise, penalties and fines are assumed.

step 4 provide the signature filling out ssa form ssa 795

Put the Date and Provide Contact Information

After you set the date of filling out the form, provide your contact details:

  • Telephone number
  • Mailing address
  • City
  • State
  • ZIP Code

step 5 put the date and provide contact information filling out ssa form ssa 795

Provide Witnesses

Witnesses do not always have to certify this form. They are necessary only if there is a corresponding mark put by the Administration representative. If there is such a mark, then two witnesses must sign the statement and provide their addresses.

step 6 provide witnesses filling out ssa form ssa 795

Mail the Completed Document

Next, the document must be sent to the SSA office.

To Sum Up

If you are required to fill out this form, the most important thing to remember is that all your statements must be truthful and factual. Giving false testimony is punishable by law. The clearer and more precise your statements are, the better.

More than 300,000 respondents fill out this form every year. SSA asks to complete it only when necessary and use the form if they really need it to deal with a specific case. The form should not contain any issues of a sensitive nature.