Statement of Claimant or Other Person

OMB 0960-0045

OMB 0960-0045

SSA uses the SSA-795 to obtain information from claimants or other persons having knowledge of facts in connection with claims for Social Security benefits or Supplemental Security Income (SSI) payments when there is no standard form to collect the needed information. SSA then uses the information to process claims for benefits or for ongoing issues related to the above programs. The respondents are applicants and recipients, or others having knowledge of facts in connection with claims for Social Security or SSI.

The latest form for Statement of Claimant or Other Person expires 2021-11-30 and can be found here.

All Historical Document Collections
Approved with change
Revision of a currently approved collection 2021-11-02
Approved without change
Revision of a currently approved collection 2018-07-27
Approved without change
Revision of a currently approved collection 2015-07-20
Approved without change
Revision of a currently approved collection 2012-08-15
Approved without change
Revision of a currently approved collection 2009-07-14
Approved without change
Extension without change of a currently approved collection 2006-06-22
Approved without change
Extension without change of a currently approved collection 2003-08-22
Approved without change
Extension without change of a currently approved collection 2000-07-14
Approved without change
Extension without change of a currently approved collection 1997-06-13
Approved without change
No material or nonsubstantive change to a currently approved collection 1996-05-10
Approved without change
No material or nonsubstantive change to a currently approved collection 1995-12-08
Approved with change
No material or nonsubstantive change to a currently approved collection 1995-03-31
Approved without change
Extension without change of a currently approved collection 1994-05-31
Approved without change
Extension without change of a currently approved collection 1991-03-08
Approved without change
Revision of a currently approved collection 1990-02-15
Approved with change
No material or nonsubstantive change to a currently approved collection 1988-04-01
Approved without change
Revision of a currently approved collection 1987-03-11
Approved without change
Extension without change of a currently approved collection 1984-05-22
Approved with change
No material or nonsubstantive change to a currently approved collection 1981-07-17
Approved without change
Revision of a currently approved collection 1980-08-20
Approved with change
No material or nonsubstantive change to a currently approved collection 1979-10-30
Approved without change
Extension without change of a currently approved collection 1978-05-16
Approved with change
No material or nonsubstantive change to a currently approved collection 1978-04-19
Approved without change
Extension without change of a currently approved collection 1978-02-01

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