APPLICATION FOR LUMP-SUM DEATH PAYMENT

ICR 198507-0960-001

OMB: 0960-0013

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
114238 Migrated
ICR Details
0960-0013 198507-0960-001
Historical Active 198211-0960-006
SSA
APPLICATION FOR LUMP-SUM DEATH PAYMENT
Revision of a currently approved collection   No
Regular
Approved without change 08/22/1985
Retrieve Notice of Action (NOA) 07/03/1985
  Inventory as of this Action Requested Previously Approved
08/31/1988 08/31/1988 11/30/1985
735,000 0 735,000
122,500 0 122,500
0 0 0

THE INFORMATION COLLECTED ON THIS FORM IS NEEDED AND USED TO DETERMINE THE ELIGIBILITY OF AN APPLICANT FOR THE LUMP-SUM DEATH PAYMENT. THE APPLICATION ELICITS ALL THE INFORMATION NECESSARY TO DETERMINE IF THE LUMP-SUM SHOULD BE PAID TO A WIDOW, WIDOWER OR CHILDREN. IT ALSO CONTAINS ITEMS APPROPRIATE FOR PAYMENT TO AN EQUITABLY ENTITLED PERSON OR TO A FUNERAL HOME IF DEATH OCCURRED PRIOR TO SEPTEMBER 1, 1981.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR LUMP-SUM DEATH PAYMENT SSA-8

  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 735,000 735,000 0 0 0 0
Annual Time Burden (Hours) 122,500 122,500 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
07/03/1985


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