Skip to content
Social Security
Search
Menu
Languages
Sign in / up
Program Operations Manual System (POMS)
Effective Dates: 07/23/2010 - Present
Previous
|
Next
TN 3 (03-95)
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