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  • Statement Of Claimant Or Other Person Name Of Claimant Medicaid Id# Name Of Person Making Statement

Get Statement Of Claimant Or Other Person Name Of Claimant Medicaid Id# Name Of Person Making Statement

Statement of Claimant or Other Person Name of Claimant Medicaid ID# Name of Person Making Statement (if other than above claimant) Relationship to Claimant Understanding that this statement is for.

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In Alabama, that period of time is 60 months (5 years). This 60 month period of time is commonly known as the medicaid lookback period. Any gifts or transfers of assets for less than market value made during the lookback period may result in a transfer penalty.

It should include details about what you were like, and what your life was like, before you became disabled. It should then describe how your disability and pain and limitations have changed the way you live, including how you interact with your family and friends, and how you have changed as a person.

(The "claimant" is the person who is requesting disability benefits.) The field office is responsible for verifying non-medical eligibility requirements, which may include age, employment, marital status, or Social Security coverage information.

What is a SSA 795? A Form SSA 795 is known as a Statement of Claimant or Other Person. It will be received and recorded by the Social Security Administration in the United States. The form will be used by a third party to make a statement about the applicant's employment or wages.

It usually takes about 45 days to process an application once all information is received by the Medicaid worker (when the application is complete). If I qualify, how will that work? If you qualify for the QI-1 program, Medicaid will tell Social Security to stop deducting this money from your Social Security check.

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.

If you would like to receive your Social Security Statement by mail, please print and complete a "Request For Social Security Statement" (Form SSA-7004) and mail it to the address provided on the form. You should receive your paper Social Security Statement in the mail in four to six weeks.

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.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232