Application for Lump-Sum Death Payment - Paper

Application for Lump-Sum Death Payment

⚠️ Notice: This information collection may be referencing outdated material.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 - Paper Form
SSA-8-F4 Application For Lump-Sum Death Payment SSA-8-F4 - Revised (Fillable).pdf Form
SSA-8-F4 - Current.pdf Current SSA-8-F4 IC Document

Information Collection (IC) Details

IC Title:	Application for Lump-Sum Death Payment - Paper	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 - Revised (Fillable).pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,164	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	8,164	8,164
Annual IC Time Burden (Hours)	1,361	1,361
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-8-F4	SSA-8-F4 - Current.pdf	06/20/2016

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