Fill Out Form SSA-795 Online in 2026
Give a certified statement about your Social Security or SSI claim when no other document fits, sign it under penalty of perjury, and download your copy for the record.
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How to fill out an SSA-795 Form
Follow the steps below and finish with no guesswork.
Open the form
Access the pre-loaded form in our editor and start with the claimant's name field.
Fill in your details
Complete every required field, including your SSN and statement, so it's valid.
Download as PDF
Save your completed statement as a PDF file, ready to print, sign, or send.
What is an SSA-795 Form?
The SSA-795 Form is a written statement you or someone else can give to the Social Security Administration when no other form fits the situation. Officially called the statement of claimant or other person (SSA-795), it collects facts related to a Social Security or SSI claim directly from the person who knows them. Because you sign it under penalty of perjury, every detail must be accurate. SSA relies on this signed record to reach a fair, timely decision on the claim.
Key Takeaways
- SSA-795 reports facts for a Social Security claim
- Used when no other SSA form fits the situation
- Statement must be signed under penalty of perjury
What is an SSA-795 Form used for?
The Social Security Administration uses this form when no standard form fits the situation. You sign the statement under penalty of perjury, so accuracy matters. People use the SSA-795 statement of claimant to:
- Explain facts about a Social Security or SSI claim in your own words
- Clarify or add details on income, work history, or eligibility
- Correct information that affects your benefit amount
- Document a phone call or office visit
- Support a waiver or reconsideration request without a formal appeal form
What information is required on an SSA-795 Form?
Name of Wage Earner, Self-employed Person, or SSI Claimant
Enter the full name of the claimant this statement concerns.
Social Security Number
Enter the claimant's Social Security Number.
Name of Person Making Statement
Enter your name here if you are not the claimant yourself.
Relationship to Claimant
State how you are related or connected to the claimant.
Statement
Write a clear, fact-based statement, avoiding opinions and inconsistencies, within about one page.
Signature and Date
Sign your name by hand and enter the date you signed.
Telephone Number and Mailing Address
Give your phone number with area code and your full mailing address.
Witnesses
If you sign with an X, have two people who know you sign and list their addresses.
When is an SSA-795 Form due?
The SSA-795 has no fixed deadline. You can file it any time your Social Security benefits claim is pending, though submitting it alongside your initial application helps avoid delays. The Social Security Administration may also ask for this statement during an appeal, a fee petition, or a review whenever it needs more details to support your claim.
Put your statement in writing
Open the SSA-795 here, fill in your statement, and download the completed form when you're done.
When is an SSA-795 not required?
You can skip the SSA-795 whenever the Social Security Administration asks for a different form or questionnaire, or offers its own version already adapted to collect your statement. Witness signatures only matter if you sign with a mark instead of your name; in that case, two people who know you must sign as witnesses. Otherwise, no witness is needed.
What does a SSA-795 form look like
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