Statement of Claimant or Other Person
Prepare an SSA-795 statement without confusing the claimant with the person giving the facts.
Official Source:Social Security AdministrationChecked Aug 2026What is SSA-795 used for?
Use SSA-795 when Social Security needs a written statement from the claimant or another person who knows the facts. Docgle prepares the current official PDF for the statement-maker to review, print, sign and date in ink, and return through the SSA channel tied to the underlying matter.
Time, difficulty & who this form is for
Average time
About 15 minutes
SSA's printed burden estimate covers reading the instructions, gathering the facts, and answering the questions; it is not an SSA processing-time promise.
Difficulty
Straightforward when the requested facts and contact details are ready
Based on the official source, the active walkthrough branches, and the details needed for the final PDF.
Best for
A claimant or another person whom SSA asked to provide a written factual statement
Check that this form fits your situation before entering personal information.
What do I need before I start?
Antes de empezar
Lo que debe saber antes de empezar.
Para qué sirve
This walkthrough keeps the claimant and statement-maker roles separate, leaves signatures and signing dates for the person signing the printed form, and never claims that SSA received or accepted the statement. The questions and completed PDF have been checked against the official source. Review your own PDF before sending it.
Tenga en cuenta
Revise nombres, fechas, firmas y documentos de respaldo antes de enviar el formulario.
Lo que necesita
The claimant's full name and Social Security number.
If someone else is giving the statement, that person's full name and relationship to the claimant.
The factual statement SSA requested, in the statement-maker's own words.
The statement-maker's telephone number and mailing address.
A way to print and sign in ink; a mark signature also needs two witnesses who know the signer.
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.
View the official PDF
Fuente del PDF
Formulario oficial en blanco
Enlaces de la fuente y copia guardada
Del emisor: https://www.ssa.gov/forms/ssa-795.pdf
Copia guardada en Docgle: https://api.staging.docgle.ai/documents/cd06f93a-2114-4840-bb26-08b6112b7439/original
Source, revision & details
Source confidence
Guided walkthrough ready
Docgle has checked this guided interview against an official source. Confirm the final result before signing or sending it while full source-to-completion certification is completed.
Walkthrough status
Guided walkthrough ready
Agency
Social Security Administration
Form identifier
SSA-795
Estimated time
About 15 minutes
Revision
Form SSA-795 (06-2022) UF
Verified
Aug 2026
Jurisdiction
United States federal statewide
Explore the form sections
What you will complete