Get the up-to-date 0960-0045 STATEMENT OF CLAIMANT OR OTHER PERSON NAME OF WAGE EARNER, SELF-EMPLOYED PERSON, OR SSI CLAIMANT SOCIAL SECURITY NUMBER NAME OF PERSON MAKING STATEMENT (If other than above wage earner, self-employed person, or SSI claimant) --2023 now

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Form SSA-795 is a multi-purpose form used to submit written requests to Social Security. The title of the form is "Statement of Claimant", and Social Security prefers to have people use the form as opposed to other types of correspondence because it contains a penalty clause for making false statements.
SSA uses Form SSA-795 in special situations where there is no authorized form or questionnaire, yet we require a signed statement from the applicant, claimant, or other individuals who have knowledge of facts, in connection with claims for Social Security benefits or SSI.
Social Security benefits come from a fund that is created by the taxes paid into the system. SSI benefits, on the other hand, come from the U.S. Treasury's general funds. 3. Additional help with medical costs with SSI.
Form SSA-795, Statement of Claimant or Other Person, is used by a third-party who needs to make a statement about the applicant's employment or wages.
Indicate the name of the claimant in the first field. Provide the Social Security Number (SSN) of the claimant. If you are not the claimant, enter your name in the box titled "Name of Person Making Statement." Specify your relationship with the claimant. Make your statement to the SSA.
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SSI is for people who are 65 or older, as well as people of any age, including children, who are blind or have disabilities. To qualify for SSI, you must also have little or no income and few resources.
1. General information for recording statements on the SSA-795. Use an SSA-795 whenever a signed statement is required or desirable, except when we request some other form or questionnaire or we can readily adapt for the statement.
The office is listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401 Security Boulevard, Baltimore, MD 21235-6401.
In most cases, you can take or mail this signed application with your documents to any Social Security office. Any documents you mail to us will be returned to you.
The office is listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401 Security Boulevard, Baltimore, MD 21235-6401.

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