GN 03960.095 Exhibit - Example of SSA-795, Statement of Claimant or Other Person (For Use in Requests for Administrative Review Under the Fee Agreement Process)

To view the form, go to SSA-795.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0203960095

GN 03960.095 - Exhibit - Example of SSA-795, Statement of Claimant or Other Person (For Use in Requests for Administrative Review Under the Fee Agreement Process) - 07/23/2010
Batch run: 09/05/2019
Rev:07/23/2010

Social Security

Program Operations Manual System (POMS)

GN 03960.095 Exhibit - Example of SSA-795, Statement of Claimant or Other Person (For Use in Requests for Administrative Review Under the Fee Agreement Process)