What Is a Ssa 795 Form

Form SSA-795, Declaration of the Applicant or Another Person, is a form used to submit a signed declaration to the United States Social Security Administration (SSA) regarding an application for Social Security benefits or Supplementary Security Income (SSI). You will discover even more SSA forms to fill out accessible with our editor. Below we have selected a number of the most popular forms included in this category. Also, remember that you can upload, fill, and edit any PDF on FormsPal. You cannot use Form SSA-795 (Claimant Declaration) to switch to your own benefits. When you applied for survivor benefits, it appears that you duly limited the scope of your claim to survivor benefits. This means that you have not yet applied for your own Social Security benefits, which you must do no earlier than 4 months before the month in which you want to apply for your own retirement benefits. So, if you want to start your own benefits from April 2021, you can submit your application in December 2020 at the earliest. Before you make a statement, you need to understand what kind of information you can provide. It may be: I conclude from your question that Social Security asked you to fill out the form, but I don`t know why. Typically, the form used to apply for Medicare Part B is a CMS-40B form (www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdf), and if you register during a special enrollment period (SEP), your employer must also complete a CMS-L564 (www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.PDF) form. If Social Security needs some sort of clarification from you on an SSA-795 form, it seems like you need to ask them for an explanation. If you are requesting continued benefit payments while your claim is being processed, ask a SSA representative to provide you with Form SSA-795, Declaration of Continued Benefits, which includes a pre-printed statement and checklist.

. There are four main types of pre-printed instructions. You depend on the type of benefits you have received and you want to continue. Just read the explanation, check the appropriate box, sign and date the document. Witnesses do not always have to certify this form. They are only required if a corresponding marking has been affixed by the administrative representative. If there is such a mark, two witnesses must sign the testimony and provide their addresses. Hello. Form SSA-795 is a versatile form used to make written requests to Social Security. The title of the form is “Applicant`s Statement,” and Social Security prefers people to use the form over other types of correspondence, as it includes a penalty clause for false information. More than 300,000 respondents complete this form each year. SSA asks you to fill it out only when needed and to use the form when they really need it to handle a particular case.

The form must not contain sensitive topics. This declaration is completed by the applicant, the applicant or any other person who can provide SSA with the required data. As a general rule, you must provide all related information about the services provided by the ISS or social security benefits. If you have to fill out this form, the most important thing to remember is that all your statements must be true and factual. False statements are punishable. The clearer and more precise your statements, the better. The information provided by the form filler may vary. Therefore, the administration allows you to enter it in an empty field and not fill items with questions. This allows the placeholder to provide additional information and remove the boundaries of the type of that information. The information provided in the form must be true and correct to the best of our knowledge and beliefs. The intentional provision of false information may result in a fine or imprisonment. Submit the completed declaration to your local social security office.

Find office addresses in your phone book under U.S. government agencies, on the official SSA website, or by phone at the toll-free number listed on the second page of the form. Note: If you are using a screen reader, we recommend that you open the form in Adobe Reader. If you do not have Adobe Reader, please click on the following link. Thank you very much! To complete the document, we recommend that you use our form creation software as well as our instructions below. .