Letter or Statement to Social Security Administration in Order to Establish Claimant's Date of Eligibility for Benefits
Overview of this form
This form is a Letter or Statement to the Social Security Administration that establishes a claimant's date of eligibility for benefits. Also known as the protective filing date, this document may serve as an application if it meets the required criteria. It is essential for individuals seeking Social Security payments or Supplemental Security Income (SSI).
Main sections of this form
- Claimant's disability date, essential for establishing the protective filing date.
- Statement of intent to file for benefits under Title II and Title XVI of the Social Security Act.
- Signature of the claimant to validate the statement.
- Claimant's personal information, including name, mailing address, phone number, Social Security number, and date of birth.
Common use cases
This form should be used when an individual becomes disabled and wishes to establish an official date for eligibility for Social Security benefits. It is critical to submit this form to the Social Security Administration before filing a full application to ensure benefits are effective from the correct date.
Who can use this document
This form is intended for:
- Individuals who have recently become disabled.
- Potential claimants for Social Security payments or Supplemental Security Income (SSI).
- Anyone needing to officially establish a protective filing date for benefits.
Completing this form step by step
- Fill in the date you became disabled.
- Provide the necessary personal information, including your full name, address, and other contact details.
- Clearly state your intention to use this letter as your protective filing date.
- Sign and date the letter to confirm its accuracy.
- Optionally, prepare a photocopy since it may be accepted in place of the original.
Does this document require notarization?
This form does not typically require notarization to be legally valid. However, some jurisdictions or document types may still require it. US Legal Forms provides secure online notarization powered by Notarize, available 24/7 for added convenience.
Common mistakes to avoid
- Failing to include the exact date of disability.
- Omitting personal information such as Social Security number or contact details.
- Not signing and dating the letter properly.
- Submitting the form without verifying local SSA requirements.
Why use this form online
- Easy access and immediate downloads of the form.
- Editable templates that can be customized according to individual circumstances.
- Guidance provided by licensed attorneys ensures compliance with legal requirements.
Legal use & context
- This form serves as a formal statement that can establish your eligibility date for benefits.
- It's essential that this form is filled out accurately to avoid delays in receiving benefits.
- This letter is part of the claims process and can enhance your case for receiving benefits if all conditions are met.
Quick recap
- This form establishes the protective filing date necessary for claiming Social Security benefits.
- It is essential to accurately complete all fields to prevent delays in the application process.
- Keep a copy of the submitted form for your records, as this document serves as a vital reference.
Form popularity
FAQ
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.
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.
An SSA 561 U2 form is also known as a Request for Reconsideration. This form is used by an individual who was denied social security disability or supplemental security income (SSI) for a medical reason. This form is an alternative to applying for reconsideration online.
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.
Back payments can be used as a down payment on a car or to make monthly payments on a car. However, the car must be used by, and owned by, the beneficiary. If the beneficiary already owns a car, the money can be used to make any necessary repairs to the vehicle.
Social Security's Representative Payment Program provides benefit payment management for our beneficiaries who are incapable of managing their Social Security or Supplemental Security Income (SSI) payments.Payees may receive an annual Representative Payee Report to account for the benefit payments received.
FFS organizations may collect a fee up to 10 percent of the total monthly benefits , up to a maximum of $82 per month, from beneficiaries entitled to disability benefits that have a drug addiction and/or alcoholism condition. SSA must authorize the higher $82 fee. When can your organization collect a fee?
Form SSA-623 requires the representative payee to account for all benefit funds issued within a particularly time period. The SSA sends notices for this form to be completed on an intermittent schedule.
In general, the income limit for SSI is the federal benefit rate (FBR), which is $794 per month for an individual and $1,191 per month for a couple in 2021. Remember, though, that not all income is countable, and so you can earn more than $794 per month and still qualify for SSI (more on this below).
