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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. Prepare an SSA-795 using the claimant's own words whenever possible.
You should start by setting out what your impairment/s is/are, i.e. you might have a condition that has a medical name or diagnosis. It is also important to talk about what the actual impairments or symptoms arising from the condition are.
You can request one online by using your personal my Social Security account, which will allow you to immediately view, print, and save a copy of the letter. You can call us to request one at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday from a.m. to p.m. local time.
SSA defines a dire need situation as one that exists when a person has insufficient income or resources to meet an immediate threat to health or safety, such as the lack of food, clothing, shelter or medical care.
To Whom It May Concern: I am writing to request consideration as a person in critical need for my Social Security disability. I require my claim to be processed as a dire need case because I cannot afford food, medicine, or shelter. I am attaching (list your attachments) to prove my circumstances are critical.
In most cases, a dire need letter will describe situations that are extreme, beyond what most disability applicants, who are already out of work and without an income are facing. This may include issues such as potential foreclosure or eviction.
If you have a problem, you should first contact your local office or call our 800 number. If you still need additional help, you may write to the Office of Public Inquiries and Communications Support. Please include your Social Security number or claim number whenever you write to us.