Person, or SSI Claimant Social Security Number 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 - Form SSA-795 (06-2022) UF Page 2 of 2 I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statemen.

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How to fill out the SSA-795 online

Filling out the SSA-795, or Statement of Claimant or Other Person, is a crucial step in the Social Security claim process. This guide will provide you with clear and comprehensive instructions to help you complete the form online effectively.

Follow the steps to successfully complete the SSA-795.

  1. Press the ‘Get Form’ button to access the SSA-795 form and open it in the online editor.
  2. Begin by entering the name of the wage earner, self-employed person, or SSI claimant in the designated field at the top of the form. Ensure correct spelling for accuracy.
  3. In the next field, provide the corresponding Social Security number of the individual whose statement is being made. Verify this number to prevent errors.
  4. If applicable, fill in the name of the person making the statement, particularly if it is not the wage earner or claimant. This should be completed in the specified section.
  5. Indicate your relationship to the wage earner, self-employed person, or SSI claimant in the provided area. Use clear terms that describe your connection.
  6. Review the certification statement carefully. By filling out this form, you are affirming that the information is accurate to the best of your knowledge.
  7. Sign the form in the area designated for the signature of the person making the statement. Ensure that the signature is in ink if printing.
  8. Fill in the date of signing, using the appropriate format of month, day, and year.
  9. Enter your telephone number along with the area code, ensuring it is reachable for any necessary follow-up.
  10. Complete the mailing address section fully, including the street address, city, state, and ZIP code.
  11. If you signed with a mark (X), include two witness signatures along with their complete addresses in the designated area.
  12. Finally, after reviewing all entered information for accuracy, proceed to save changes, download, print, or share the completed form as needed.

Start completing your SSA-795 online today and ensure a smooth application process.

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