Form SSA-795, Statement of Claimant or Other Person is a form used for providing the Social Security Administration (SSA) with a signed statement regarding an application for Social Security benefits or Supplemental Security Income (SSI). The latest version of the statement - also known as the SSA Form 795 - was issued by the SSA in September 2015.
An SSA-795 fillable form is available for download and digital filing below or on the SSA official website.
Form SSA-795 is most often used in case of reconsideration of an individual's eligibility to receive the SSA benefits. It may be submitted to request continuation of receiving benefits while you are working on your appeal. Besides, you can use the SSA statement of claimant form to provide a valid reason why you were not able to file your appeal in time.
The SSA uses the information you provide via the SSA-795 to process:
Submitting this form is voluntary. However, if you do not provide the requested information, it may affect the SSA ability to evaluate the decision on your claim.