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 - It is my intention to become a citizen of the United States...
statement of claimant or other person form

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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

Video instructions and help with filling out and completing statement of claimant or other person form

Far from human habitat deep in the jungles amid animals.. Live 7 brothers. That is the reason why bestiality is seen in them They lunge when happy and punch the ones they love. Get up! Rogues sleep for 28 out of 24 hours! Get up!! I'll count to three and if you still don't get up.. You'll dip in water and drench your bodies.. And scrub yourselves with soap! All right, don't.. One! Two! No!! -We're up!! Open your eyes and look at me. And hear me carefully. You'll milk the cow. If she refuses to yield? -I'll make mincemeat out of you! Chop wood and fill the godown. -The axe is blunt. Use a razor then. Buddhu. -Budh! -Yeah. Clean the stables and the chicken coop. Why clean it? We won't smell the aroma of cow dung Sniff at yourself. You'll find the smell. Irrigate the field. -What's the point? We'll eat out. One punch will knock you out for life! You'll cook but first do the dishes. Who wants to touch water? -Then I'll drown you into it. Cut the grass and gather it in the backyard. Why? Grass grows there. The cattle can go there and graze Grains grow in the field. So why should we cook it? Eat like in the fields. Come. -Ravi. This is unfair. You order us around everyday. Milk the hens.. Chop the horse's wood Clean the stable of the field. And you sit comfortably watching us! I'm your elder brother. Who is like a father and the sons must obey the Dad! Does paternal love diminish if the Dad works to help the sons? What is paternal love? Similar to motherhood! Will it matter to you? -Yes. Yes because I'm your commander. The commander plans the war. He doesn't step in for battle. Fine then each of us should get a chance to be commander! That's right! -Just a minute.. Who wants what chance? Each of us wants to be commander for a day. Those who want to be commander step forward. Stand in line. So you want to be commander? -Yes! If you don't get the chance.. -We'll go on strike! We'll raise our voice against injustice! Fulfill our demands! Now what is your answer to our demands? You want an answer? -Yes. Simple.. Rogues want to be commander! Lunch is ready!! This guy will get us all beaten! I'm hungry! -Get lost! Are you feeling well? I mean are you only going to eat this much? That's for you. I'll starve to death! Fire!!! Sunny! Sunny! We must teach Sunny a lesson! We always forgive him because he's the youngest! He fools us everyday. Sometimes he faints.. At times he feigns stomach ache Fakes fever with an onion in arm What will you do? -You tell us. What are you mumbling? We have a heavy head. It must contain a small brain! Think!! -Not our cup of tea. Try..- Can't. -I got it! Carries weight! Too much.. -He's coming. "My heart skips a beat.." Can't believe Ravi would be so good to give us this chance. Why won't he? We're his younger brothers. We may look different but our hearts are one. What is the matter? -I'll tell you. Ravi has set a condition. Anyone who wins it.. He gets a break of 7 days. He'll get milk and cream every hour and...

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Please select a version for Fillable SSA-795 form
  • 2015-09 SSA-795 Fillable
  • 2015-03 SSA-795 Fillable
  • 2009 SSA-795 Fillable
  • 2002 SSA-795 Fillable
  • More...