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Statement of claimant or other person

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The document is a form from the Social Security Administration (SSA) titled 'Statement of Claimant or Other Person.' It is used to report out-of-pocket expenses related to medications for individuals with disabilities who are applying for Supplemental Security Income (SSI) benefits. The form requires details about the claimant's medications, associated costs, and proof of these expenses. It also includes privacy information regarding the use of personal data provided in the form.

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