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Get SSA-795 2022-2024

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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