--- title: SSA-795 Customer-Assembly Preparation Kit description: Prepare SSA-795 online and receive an unsigned printed kit for your own final review, hand-signing, assembly, and submission. seotitle: SSA-795 Customer-Assembly Preparation Kit seo-description: Prepare SSA-795 online and receive an unsigned printed kit for your own final review, hand-signing, assembly, and submission. group: resources indexable: true llms: false schema: webpage og-image: /forms/ssa-795/thumbnail og-image-alt: SSA-795 — Statement of Claimant or Other Person generated form preview published: 2026-07-12 updated: 2026-07-12 tags: - social security - ssa - benefits - disability - statements path: /forms/ssa-795 --- # SSA-795 Customer-Assembly Preparation Kit Prepare SSA-795 online and receive an unsigned printed kit for your own final review, hand-signing, assembly, and submission. ## How it works 1. **Answer the guided questions and review the prepared form information.** - 2. **PostalForm prints the official form with signature areas left blank and sends the customer-assembly kit only to your verified address.** - 3. **After delivery, follow the cover instructions, hand-sign where required, and add every original, certified record, payment, witness, certification, companion form, or other physical item.** - 4. **Verify the current deadline and destination, then personally complete final submission through the official channel.** - ## Form summary This workflow helps you prepare an SSA-795 factual statement requested by Social Security. PostalForm prepares the official form and delivers the unsigned preparation kit only to your verified address. PostalForm does not file, serve, or submit it. Review the statement, hand-sign and date it in ink, complete any witness section required for an X mark, add requested evidence, and return it to the SSA office handling the matter yourself. ## What you need - Name and Social Security number of the person the record belongs to - What SSA asked you to explain (check the letter or ask the representative) - Your statement, in your own words - Signature, date, mailing address, and a daytime phone number - Hand-sign the printed form after the preparation kit is delivered - Supporting documents (optional) (optional) — If SSA asked you to include proof — pay stubs, letters, or receipts — add it to the customer kit before final submission. ## Data collected - Name and SSN of the person the Social Security record belongs to - Name and relationship of the person making the statement, when different - The statement text in the writer’s own words - Mailing address and daytime phone; signature, date, and any X-mark witness fields remain blank ## Where it gets mailed PostalForm mails the unsigned preparation kit only to the customer or authorized signer at the verified delivery address entered during checkout. Final submission: Review the statement, hand-sign and date it in ink, complete any witness section required for an X mark, add requested evidence, and return it to the SSA office handling the matter yourself. ## Packet order - Customer assembly instruction cover (remove and keep before final submission) - Prepared unsigned form (signature and reserved third-party fields blank) - Printed reference attachments ## Common mistakes - Arguing or pleading instead of stating facts — SSA wants dates, names, places, and amounts. - Leaving out the claimant’s Social Security number, so the statement can’t be matched to the claim. - Missing the reply deadline printed on the SSA letter that asked for the statement. - Mailing it to SSA headquarters in Baltimore instead of the local office handling the claim. - Forgetting the two required witnesses when the statement is signed with an X mark. ## Agent summary Customer-assembly workflow for SSA-795. It prepares the form and sends an unsigned kit only to the customer. It must never be represented as direct filing, service, or agency submission. Final customer action: Review the statement, hand-sign and date it in ink, complete any witness section required for an X mark, add requested evidence, and return it to the SSA office handling the matter yourself. ## For assistants This is a human-only customer-assembly workflow and is not available for automated or machine ordering. - PostalForm delivers an unsigned preparation kit only to the customer or authorized signer. - The customer must remove and keep the PostalForm cover, complete every physical signature, enclosure, certification, and final-submission step, and verify the current deadline and destination. ## LLM field schema ```json [ { "id": "about_someone_else", "label": "Are you making this statement about someone else's Social Security record?", "type": "checkbox", "required": true, "meta_class": "yes_no", "ui_width": null, "group_id": "step-1-claimant", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "statement_author_name", "label": "Your full name (the person making this statement)", "type": "text", "required": true, "meta_class": "name", "ui_width": null, "group_id": "step-1-claimant", "choice_group": null, "choice_label": null, "visibility": { "fieldId": "about_someone_else", "operator": "truthy" }, "compound_subfields": null }, { "id": "relationship_to_claimant", "label": "Your relationship to that person", "type": "text", "required": true, "meta_class": null, "ui_width": null, "group_id": "step-1-claimant", "choice_group": null, "choice_label": null, "visibility": { "fieldId": "about_someone_else", "operator": "truthy" }, "compound_subfields": null }, { "id": "wage_earner_name", "label": "Name of the person the Social Security record belongs to", "type": "text", "required": true, "meta_class": "name", "ui_width": null, "group_id": "step-1-claimant", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "wage_earner_ssn", "label": "That person's Social Security number", "type": "text", "required": true, "meta_class": "ssn", "ui_width": null, "group_id": "step-1-claimant", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "statement_details", "label": "Your statement", "type": "textarea", "required": true, "meta_class": null, "ui_width": null, "group_id": "step-2-statement", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "statement_signature", "label": "Your signature", "type": "signature", "required": true, "meta_class": null, "ui_width": null, "group_id": "step-3-signature", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "signature", "label": "Signature of person making statement", "type": "signature", "required": true, "meta_class": null, "ui_width": null, "group_id": "step-3-signature", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "signature_date", "label": "Date signed", "type": "text", "required": false, "meta_class": "date", "ui_width": "half", "group_id": "step-3-signature", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "phone", "label": "Daytime phone number", "type": "text", "required": false, "meta_class": "phone", "ui_width": "half", "group_id": "step-3-signature", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "mailing_address", "label": "Your mailing address", "type": "text", "required": true, "meta_class": "address", "ui_width": null, "group_id": "step-3-signature", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "city_state", "label": "City and state", "type": "compound", "required": true, "meta_class": null, "ui_width": null, "group_id": "step-3-signature", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": [ { "id": "city", "label": "City", "metaClass": "city", "required": true, "uiWidth": "half" }, { "id": "state", "label": "State", "metaClass": "state", "required": true, "uiWidth": "half" } ] }, { "id": "zip", "label": "ZIP code", "type": "text", "required": true, "meta_class": "zip", "ui_width": "half", "group_id": "step-3-signature", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "signed_by_mark", "label": "The signer can only make an X mark instead of a signature", "type": "checkbox", "required": false, "meta_class": "plain_checkbox", "ui_width": null, "group_id": "step-3-signature", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "witness_1_signature", "label": "Witness 1 — full name", "type": "text", "required": false, "meta_class": null, "ui_width": null, "group_id": "step-4-witnesses", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "witness_1_address", "label": "Witness 1 — address", "type": "textarea", "required": false, "meta_class": null, "ui_width": null, "group_id": "step-4-witnesses", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "witness_2_signature", "label": "Witness 2 — full name", "type": "text", "required": false, "meta_class": null, "ui_width": null, "group_id": "step-4-witnesses", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "witness_2_address", "label": "Witness 2 — address", "type": "textarea", "required": false, "meta_class": null, "ui_width": null, "group_id": "step-4-witnesses", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null } ] ``` ## Sources - [SSA field office locator](https://www.ssa.gov/locator) - [SSA — Submit forms and upload documents online](https://www.ssa.gov/manage-benefits/submit-forms-upload-documents) - [Official instructions](https://secure.ssa.gov/apps10/poms.nsf/lnx/0200301305) - [Official PDF](https://www.ssa.gov/forms/ssa-795.pdf) ## Last verified 2026-07-12 ## FAQs - **What is Form SSA-795 used for?** Social Security uses the SSA-795 whenever it needs a signed statement and no dedicated form exists — for example, explaining work activity, living arrangements, a marriage or separation, how you manage funds, or any fact an SSA representative asked you to put in writing. - **Where do I mail Form SSA-795?** To the office handling your claim. Use the return address on the letter SSA sent you, or look up your local office with SSA’s office locator. Don’t send it to SSA headquarters in Baltimore — that address is only for paperwork-burden comments. - **What should I write in the statement?** Answer exactly what SSA asked, in the first person, with specific dates, names, places, and dollar amounts. It is signed under penalty of perjury, so only include things you know are true. - **Can I submit the SSA-795 online instead of mailing it?** Yes — SSA’s “Upload Documents” tool in a my Social Security account accepts the SSA-795 electronically. Use this preparation kit only when you want to finish and submit a paper form yourself. - **Is there a fee or a processing time?** No fee. The statement becomes part of your claim file, and the office that asked for it reviews it as part of that claim — so mail it promptly, especially if your letter lists a deadline. ## Related - [SSA-1696 — Appointment of Representative (Social Security)](/forms/ssa-1696) - [SSA-827 — Authorization to Disclose Information to SSA](/forms/ssa-827) - [Form SS-5 — Application for a Social Security Card](/forms/ss-5) - [SSA-3288 — Consent for Release of Information](/forms/ssa-3288) - [Form SSA-44 — Medicare IRMAA Reduction Request (Life-Changing Event)](/forms/ssa-44) - [SSA-7008 — Request for Correction of Earnings Record](/forms/ssa-7008)