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...
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Who needs a 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

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Hi there this is Jonathan Ginsberg I'm a social security disability attorney and today I'd like to talk to you about Social Security disability forms all those forms you have to fill out when you apply for disability you file appeals and if you've been in this at all you know that there is well over 100 pages of forms and they just seem to be endless asking the same questions over and over and I actually wrote a book about these forms called the disability answer guide which you can see at WWDC bility forms calm so I do look at these forms a good bit when I update the book so I see what Social Security is doing what they're asking and I think that you may found my perspective a little bit helpful here so first of all just to give you some perspective understand that Social Security the people who make these forms up these nameless people up in Washington who do this they don't ever consolidate what they're asking they basically asked the same questions over and over and they keep adding questions to these forms so three or four years ago we might have a form that was say three pages now it's five pages three or four years ago a five page form has turned into now a seven page form and they just asked the same questions over and over and over so it's not really your imagination when you look at these forms and you see that Social Security seems to be asking you the same thing over and over and over what part of your body hurts how does it impact you and so forth so that's one of the things you need to realize and just deal with that there's nothing we can do about that that the forms are really asking the same questions over and over and over I think it's very important that when you complete the forms you keep in mind the definition of disability because everything you say in these forms really needs to be focused on proving one thing and that is that you meet Social Security's definition of disability which of course is that you do not have the capacity to perform the duties of a simple entry-level job so this is not about what you can or cannot do around your house or it's not about what you can or cannot do in a past job this is basically saying if there was a simple entry-level job or basically you had to show up and be breathing what I call a warm body job could you perform the duties of the job and that's really what these forms are to get at so when you answer the questions in the forms don't say things like I can't lift very much or I can't walk very far you want to be very very specific and talk about those things that you can or cannot do that would have relevance in a work setting for example if you have limitations on lifting talk about how you can only lift five to seven pounds maybe once or twice a day if you're talking about walking that your capacity to walk has been reduced so that you're going back and forth to the mailbox which was maybe 15 or 20 yards you became become fatigued after doing that if the problem is more mental we...