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www.ssa.gov/privacy. Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995.
If you download, print and complete a paper form, please mail or take it to your local Social Security office or the office that requested it from you. Important Note: PDFs you open from this page may default to opening within a browser, depending on your browser settings.
Complete a Statement of Claimant or Other Person (Form SSA-795) (PDF). Gather supporting information that includes: A brief explanation of your work status or income change. The date of the change. Fax or mail the form along with any supporting documents to your local office. Find your local office
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. §3507, as amended by Section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number.
Social Security Administration Form Approved OMB No. 0960-0045 STATEMENT OF CLAIMANT OR OTHER PERSON Name of Wage Earner, Self-employed Person, or SSI Claimant Name of Person Making Statement (If other than above wage earner, self-employed person, or SS/ claimant) Social Security Number Relationship to Wage Earner, Self-Employed
Use the latest version of the SSA-795, Statement of Claimant or Other Person, available on the SSA e-forms with the following language. “I (print full name of individual or representative payee) Claim
We estimate that it will take about 15 minutes to read the instructions, gather the facts, and answer the questions. SEND THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).