OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Statement of Claimant or Other Person

OMB 0960-0045 ยท SSA.

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 2028-05-31 and is listed under ICR 202502-0960-016.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-795 Statement of Claimant or Other PersonForm
Form SSA-795 Statement of Claimant or Other Person (Paper /in-office interview)Form
Supporting Statement - 0045.docxSupporting Statement A
Statement of Claimant or Other Person (Paper /in-office interview) Form
Statement of Claimant or Other Person (Paper /in-office interview) Form
Statement of Claimant or Other Person (Paper /in-office interview) Other-SSI Claim System Remarks Screen
Statement of Claimant or Other Person (Telephone interviews) Other-SSI Claim System Remarks Screen

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202502-0960-016 Revision of a currently approved collection 2025-04-17
202110-0960-001 Revision of a currently approved collection 2021-11-02 Approved with change
201803-0960-004 Revision of a currently approved collection 2018-07-27 Approved without change
201503-0960-010 Revision of a currently approved collection 2015-07-20 Approved without change
201205-0960-004 Revision of a currently approved collection 2012-08-15 Approved without change
200901-0960-011 Revision of a currently approved collection 2009-07-14 Approved without change
200606-0960-021 Extension without change of a currently approved collection 2006-06-22 Approved without change
200308-0960-004 Extension without change of a currently approved collection 2003-08-22 Approved without change
200007-0960-003 Extension without change of a currently approved collection 2000-07-14 Approved without change
199706-0960-005 Extension without change of a currently approved collection 1997-06-13 Approved without change
199605-0960-012 No material or nonsubstantive change to a currently approved collection 1996-05-10 Approved without change
199512-0960-009 No material or nonsubstantive change to a currently approved collection 1995-12-08 Approved without change
199503-0960-009 No material or nonsubstantive change to a currently approved collection 1995-03-31 Approved with change
199405-0960-004 Extension without change of a currently approved collection 1994-05-31 Approved without change
199103-0960-001 Extension without change of a currently approved collection 1991-03-08 Approved without change
199002-0960-002 Revision of a currently approved collection 1990-02-15 Approved without change
198804-0960-004 No material or nonsubstantive change to a currently approved collection 1988-04-01 Approved with change
198703-0960-003 Revision of a currently approved collection 1987-03-11 Approved without change
198405-0960-011 Extension without change of a currently approved collection 1984-05-22 Approved without change
198107-0960-010 No material or nonsubstantive change to a currently approved collection 1981-07-17 Approved with change
198008-0960-003 Revision of a currently approved collection 1980-08-20 Approved without change
197910-0960-004 No material or nonsubstantive change to a currently approved collection 1979-10-30 Approved with change
197805-0960-004 Extension without change of a currently approved collection 1978-05-16 Approved without change
197804-0960-009 No material or nonsubstantive change to a currently approved collection 1978-04-19 Approved with change
197802-0960-008 Extension without change of a currently approved collection 1978-02-01 Approved without change

OMB Details

Statement of Claimant or Other Person (Paper /in-office interview)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form SSA-795Statement of Claimant or Other PersonFillable PrintableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.