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. After setting the date to complete the form, provide your contact information: Form SSA-795, Declaration of applicant or other person, is a form used to provide the United States Social Security Administration (SSA) with a signed statement regarding an application for Social Security benefits or supplementary security income (SSI). Most often, the applicant is asked to complete the form for their specific needs and cases only if they are already receiving benefits from programs sponsored by SSI or social security services. In addition, the administration can also address friends, relatives, colleagues, employers of this person with this special form. Before you make a statement, you need to understand what kind of information you can provide. It may be that the information provided in the form is true and correct to the best of our knowledge and belief. 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. 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. Form SSA-795 is most commonly used when reconsidering a person`s eligibility to receive SSA benefits. It can be submitted to request the continuation of the benefit while you work on your appeal. You can also use the applicant`s SSA declaration form to provide a valid reason why you were unable to file your complaint in a timely manner. 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. Some information may also be collected during an in-person interview or by telephone. But the option to fill out the form is the most common. To complete the document, we recommend that you use our form builder software as well as our instructions below. 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. Therefore, the SSA requires that you fill out exhaustive information that may relate to: The Social Security Administration (SSA) seems to have the necessary form for each occasion.
For example, in certain situations where none of the authorized forms apply to the clause, the SSA will ask applicants to complete Form 795. This document is also called a statement from the applicant or another person. The SSA uses the information you provide through SSA-795 to resolve ongoing eligibility issues, determine eligibility for Social Security benefits and ISS, use funds from a representative beneficiary, investigate fraud and other program-related issues. The latest version of the statement was issued on February 1, 2020. A completed Form SSA-795 is available for download and digital submission via the following link. This document consists primarily of a series of blank lines to fill in the applicant`s contact information, a large empty space in the body to explain the nature of your problem, and a penalty clause for submitting false or otherwise invalid information. I conclude from your question that Social Security asked you to fill out the form, but I do not 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. 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.
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. I am now receiving a survivor benefit based on my wife`s record and would like to change to receive the benefit based on my own record, which will be higher when I turn 70 in April 2021. I was told to fill out SSA 795, but I don`t know how. I have three questions. 1. What should I put on the first page of the form under the large space after confirming this? 2. When do I need to submit the form to receive the new benefit when I turn 70 in April 2021? 3.
Where do I send the form and must it be submitted electronically or by mail? Thank you for your support. The finding of fact should not raise any questions. Facts are accurate information provided by a person with irrefutable knowledge, while opinions can be questioned and depend on the subject`s angle of view. These are just beliefs that need to be tested. 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. 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.
Why do I have to complete Form SSA-795 if I have never received benefits? I`m trying to have Medicare Part B on site when I retire at the end of December. I am still employed and covered by my employer`s health plan and am recently enrolled in Medicare PartA. I am 66 years and 3 months old, so I am in my normal retirement age. I just don`t understand this form and what to write on it. Instructions for completing Form SSA 795 may depend on why you are submitting it. If you are not sure how to make a correct declaration, go to the nearest social security office and an authorized official will give you the appropriate instructions. If you fill out the document that does not concern you, write in these lines your name and the degree of your relationship with the applicant (parent, spouse, friend, neighbour, colleague, etc.). Ideally, your application should meet the following requirements: You must provide the name and social security number of the person affected by this document whose case is currently under review.
It can be yourself or another person. With your signature, you confirm your testimony and declare that all your testimony was given honestly. Otherwise, penalties and fines will be accepted. At this point, you need to give the statement yourself. We recommend that you refer to the above tips for a successful application. Remember to keep it short and clear. It is recommended to refrain from evaluative characteristics and give only the facts. Under Section 205(a) of the Social Security Act, the SSA may collect additional evidence to determine a citizen`s eligibility. In accordance with 20 CFR 404.702 and 416.570 of the Code of Federal Regulations, individuals use this document to assert claims related to benefits. The general instructions for completing form SSA 795 are as follows: I don`t know if you can apply for your benefits online or not, but if you can`t, you can call Social Security to make an appointment to apply.. .