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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...
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SSA-795 Form Versions

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SSA-795 2015-09 4.9 Satisfied
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SSA-795 2015-03 4.4 Satisfied
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SSA-795 2009 4.0 Satisfied
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SSA-795 2002 3.8 Satisfied
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