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Certify that -. Form SSA-795 (8-2002) EF (12-2002) Destroy Prior Editions ... the Paperwork Reduction Act of 1995. You do not need to answer these questions .

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How to fill out the Ssa 795 online

The Ssa 795 form, also known as the Statement of Claimant or Other Person, is essential for providing information to the Social Security Administration. This guide will help you navigate the online completion of this form with clear and supportive instructions.

Follow the steps to fill out the Ssa 795 form online

  1. Use the ‘Get Form’ button to access the Ssa 795 form and open it in your selected editing tool.
  2. In the first section, provide the name of the wage earner, self-employed person, or SSI claimant. This is critical for identifying the individual relevant to the information being provided.
  3. If you are not the wage earner, self-employed person, or SSI claimant, fill in your name in the appropriate field. Ensure that this information is accurate to avoid any miscommunication.
  4. Next, enter the social security number of the wage earner, self-employed person, or SSI claimant. This step is vital for proper processing by the Social Security Administration.
  5. Indicate your relationship to the individual named in the previous fields. Be precise to ensure that the nature of your association is clearly understood.
  6. Read and understand the certification statement. By signing, you declare that the information provided is true and correct to the best of your knowledge.
  7. Add your signature in the designated area. This should include your first name, middle initial (if applicable), and last name, written in ink.
  8. Date your signature by filling in the date in the prescribed format (month, day, year). This is important for documentation purposes.
  9. Provide your telephone number with the area code for any possible follow-up questions from Social Security representatives.
  10. Complete the mailing address section with your current address. This should include the street number and name, apartment number (if applicable), city, state, and ZIP code.
  11. If you signed the form with a mark (X), ensure that two witnesses sign below, providing their full addresses. Note that witnesses are not required if the signature is not a mark.
  12. Once you have completed all sections, review your entries for accuracy. Save your changes and then proceed to download, print, or share your completed form as needed.

Get started on filling out your Ssa 795 form online today!

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A representative payee is someone who manages the patient's money to make sure the patient's needs are met. The payee has a strong and continuing interest in the patient's well-being and is usually a family member or close friend. incapable of managing his/her own money.

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 SSA-787, Medical Source Opinion of Patient's Capability to Manage Benefits, is the preferred vehicle for obtaining medical evidence of capability.

SSA uses the information from Form SSA-788 to verify payee applicants' statements of concern and to identify other potential payees. SSA is concerned with selecting the most qualified representative payee who will use Social Security benefits in the beneficiary's best interest.

Where do I send form SSA-795? 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.

(b) Examples of circumstances where good cause may exist include, but are not limited to, the following situations: (1) You were seriously ill and were prevented from contacting us in person, in writing, or through a friend, relative, or other person. (2) There was a death or serious illness in your immediate family.

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.

SSA and its affiliated State disability determination services use Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)" to obtain medical and other information needed to determine whether or not a claimant is disabled.

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