Why do I have to fill out form SSA-795 if I have never received benefits? I am trying to have Medicare part B in place for when I retire at end of December. I am still currently employed and covered under my employers health care plan and recently enrolled in Medicare PartA. I am 66 years and 3 months old so I am at my normal retirement age. Just don’t understand this form and what I’m supposed to write on it.

Hi. Form SSA-795 is a multi-purpose form used to submit written requests to Social Security. The title of the form is "Statement of Claimant", and Social Security prefers to have people use the form as opposed to other types of correspondence because it contains a penalty clause for making false statements.

I infer from your question that Social Security has asked you to complete the form, but I have no idea why. Normally, the form used to apply for Part B of Medicare is a form CMS-40B (https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdf), and if you enroll during a special enrollment period (SEP) then your employer also needs to complete a form CMS-L564 (https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.PDF). If Social Security needs some type of clarification from you on a form SSA-795, it sounds like you'll need check with them for an explanation.

Best, Jerry