Social Security Administration
SSA-795 Statement of Claimant or Other Person
Prepare a clear statement for Social Security, with the right person and signer details.
What is SSA-795 used for?
Answer a short set of plain-English questions, review the statement, then print and sign the official SSA-795.
Prepare a clear statement about the right person, then have the person speaking for the facts sign it in ink.
The signer declares the information true and correct under penalty of perjury, and signing by mark requires two witnesses.
Time, difficulty & who this form is for
Average time
About 15 minutes
Difficulty
simple
Best for
Giving SSA a signed statement about yourself or someone else
What do I need before I start?
- The full name and Social Security number of the person this form is about
- The facts the person giving them needs to tell SSA
- The phone number and mailing address of the person who will sign
- Two witnesses who know the signer only if the person will sign by mark; their signatures and addresses stay on the official form
How the walkthrough is organized
People
Identify who this form is about and who is giving the facts.
Statement
Write the facts the signer will certify as true.
Contact and signature
Add the signer's contact details and learn any manual witness requirement.
Review
Check the completed form, print it, and collect the required ink signatures.
What happens after I complete it?
Review the populated official PDF, print it, then have the statement-maker sign and date it in ink. If they sign by mark, two people who know the signer must also sign and give their full addresses on the form.
Where it goes
The SSA office or delivery channel requested or made available for the underlying claim or matter; SSA-795 itself does not give one universal destination.
Downloading does not submit the form or confirm acceptance.