Application for Lump-Sum Death Payment; 404.390 - 404.392

Application for Lump-Sum Death Payment, 404.390 - 404.392

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0013 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-8-F4 Application for Lump-Sum Death Payment; 404.390 - 404.392 Form
SSA-8-F4 Application For Lump-Sum Death Payment SSA-8-F4.pdf Form

Information Collection (IC) Details

IC Title:	Application for Lump-Sum Death Payment; 404.390 - 404.392	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.390-404.392

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8-F4	Application For Lump-Sum Death Payment	SSA-8-F4.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29,350	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	29,350	-14,500	43,850
Annual IC Time Burden (Hours)	4,892	-2,416	7,308
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.