Application for Lump Sum Death Payment

ICR 200012-0960-002

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
8889 Migrated
ICR Details
0960-0013 200012-0960-002
Historical Active 199709-0960-004
SSA
Application for Lump Sum Death Payment
Extension without change of a currently approved collection   No
Regular
Approved without change 01/16/2001
Retrieve Notice of Action (NOA) 12/13/2000
  Inventory as of this Action Requested Previously Approved
03/31/2004 03/31/2004 01/31/2001
877,000 0 735,000
146,167 0 122,500
0 0 0

The information collected is required to authorize payments of the lump-sum death benefit to a widow, widower, or children as defined in Section 202(i) of the Social Security Act. The respondents are widows, widowers or children who apply for a lump-sum death payment.

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 877,000 735,000 0 0 142,000 0
Annual Time Burden (Hours) 146,167 122,500 0 0 23,667 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.
12/13/2000


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