Application for Lump-Sum Death Payment

ICR 201902-0960-006

OMB: 0960-0013

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Unchanged
Supplementary Document
2019-02-11
Justification for No Material/Nonsubstantive Change
2019-02-13
ICR Details
0960-0013 201902-0960-006
Historical Active 201603-0960-004
SSA
Application for Lump-Sum Death Payment
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 02/25/2019
Retrieve Notice of Action (NOA) 02/13/2019
  Inventory as of this Action Requested Previously Approved
08/31/2019 08/31/2019 08/31/2019
670,248 0 670,248
100,674 0 100,674
0 0 0

SSA uses Form SSA-8-F4 to collect information needed to authorize payment of the lump-sum death payment (LSDP) to a widow, widower, or children as defined in Section 202(i) of the Act. Respondents complete the application for this one-time payment via paper form, telephone, or during an in-person interview with SSA employees. Respondents are applicants for the LSDP. This is a non-substantive Change Request to include the new Preliminary Claims System screens.

US Code: 42 USC 402 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  81 FR 19283 04/04/2016
81 FR 39990 06/20/2016
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 670,248 670,248 0 0 0 0
Annual Time Burden (Hours) 100,674 100,674 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$89,841
No
    Yes
    Yes
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/13/2019


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