Form Ssa 795 Form

Form SSA-795, Statement of Claimant or Other Person, is used by a third-party who needs to make a statement about the applicant's employment or wages. The most common third-party individuals who complete this form include a work supervisor, another employee, a bank where the person cashes or deposits their payroll check, or a union official. Generally, the information includes where the applicant works, how long they worked there, their salary, and how many hours the applicant works in a given week.

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. This party could be a work supervisor, a fellow employee, a bank where you regularly deposit your checks, or a union official.
The person filling out this form must be able to include detailed information about the applicant’s current income and wages. This can include how long they have been working, what their salary is, and how many hours they work each week. The form will need to be signed and dated so that it can be used as an official statement.

How to complete an SSA 795 (Step by Step)

To complete a Form SSA-795, you will need to provide the following information:

  • Name
  • Social security number
  • Name of person making statement
  • Relationship to wage earner, self-employed person, or SSI claimant
  • Certified statement that is for the Social Security Administration
  • Signature of person making statement
  • Date
  • Telephone number
  • Mailing address
  • Witnesses signatures and addresses

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Sample Form Ssa 795

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Sample Form Ssa 795

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