This form is used to establish a date on which a claimant's eligibility for benefit payments is determined (sometimes called the protective filing date). An application must be filed with the Social Security Administration before one can be entitled to Social Security payments or Supplemental Security Income (SSI). A letter, filed with the SSA, may serve as an application if all of the necessary requirements are met.
Nebraska Letter or Statement to Social Security Administration in Order to Establish Claimant's Date of Eligibility for Benefits
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US-01279BG
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How to fill out Letter Or Statement To Social Security Administration In Order To Establish Claimant's Date Of Eligibility For Benefits?
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FAQ
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.
Individuals use Form SSA-795 to make signed statements relating to claims for Social Security benefits or Supplemental Security Income (SSI) payments under 20 CFR 404.702 and 416.570 of the Code of Federal Regulations.
If you want to keep yours, here are some tips on how to pass a continuing disability review:Follow Your Treatment Protocol.Learn More About Your Condition.Answer the Short Form Honestly.Keep Copies of Your Medical Records.Inform the SSA of Any Change in Address.
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.
A Statement is available to any adult worker who does not receive benefits. Your unique Statement gives estimates of future Social Security benefits that you and your family may receive each month along with a basic overview of the Social Security program.
(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.
We can provide you with a benefit verification letter, sometimes called a budget letter, a benefits letter, a proof of income letter, or a proof of award letter. You may also need proof that you have never received Social Security benefits or SSI or proof that you have applied for benefits.
Indicate the name of the claimant in the first field. Provide the Social Security Number (SSN) of the claimant. If you are not the claimant, enter your name in the box titled "Name of Person Making Statement." Specify your relationship with the claimant. Make your statement to the SSA.
If you need to replace your original award letter, you can request a copy by calling Social Security at 800-772-1213 or visiting your local SSA office.
If you decide to appoint someone to help you with your case, you must tell us in writing. You can sign and submit a written statement appointing the person, or use our standard form SSA-1696, Appointment of Representative.
