SUPPORTING STATEMENT FOR FORM SSA-721
STATEMENT OF DEATH BY FUNERAL DIRECTOR
20 CFR 404.715 and 404.720
OMB No. 0960-0142
Section 202(d) of the Social Security Act and section 20 CFR 404.715 of the Code of Federal Regulations mandate that when an SSA-insured worker dies, the Social Security Administration (SSA) must provide death benefit payments to the appropriate surviving family member. Before making these payments, SSA must obtain evidence of the insured individual’s death. SSA considers a funeral director’s statement to be a preferred type of such evidence (as per 20 CFR 404.720). SSA uses form SSA-721, the Statement of Death by Funeral Director, to obtain a funeral director’s confirmation of death for an SSA-covered individual.
When an SSA-insured worker dies, the funeral director/home responsible for the worker’s burial or cremation completes form SSA-721 and sends it to SSA. SSA can use this information for three purposes: 1) to establish proof of death for the insured worker; 2) to determine if the insured individual was receiving any pre-death benefits that SSA needs to terminate; and 3) to ascertain which surviving family member is eligible for the lump-sum death payment or for other death benefits.
SSA has not created a directly corresponding electronic version of form SSA-721 under the Government Paperwork Elimination Act plan. However, we do have an Internet-based collection instrument, the Electronic Death Registry (OMB No. 0960-0700), that funeral directors can use to electronically submit similar information to SSA.
The nature of the information SSA is collecting and the manner in which we are collecting it preclude duplication. SSA does not use any other paper collection instrument to collect data similar to the data we are collecting here (an electronic exception is 0960-0700; see #3, above, for details).
This information collection does not significantly affect small businesses or other small entities. SSA attempts to reduce the burden of this collection by providing funeral homes with a relatively short, standardized form for reporting deaths.
If SSA did not conduct this information collection, the Agency would be losing a valuable source of confirming insured individuals’ deaths, which would affect the issuance of death benefits and the elimination of other benefits the individual had received pre-death. Since funeral directors only complete this form once, when a death occurs, we cannot collect the information less frequently.
There are no technical or legal obstacles that prevent burden reduction.
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
SSA published the Advance 60-day Federal Register Notice on April 28, 2008, at 73 FR 22989, and we did not receive any public comments. We published the 30-day Federal Register Notice on July 1, 2008, at 73 FR 37524. If the Agency receives any public comments in response to this Notice, we will forward them to OMB.
SSA has not consulted the public in the development or maintenance of this form.
SSA provides no payment or gifts to the respondents.
SSA protects and holds confidential the information we are requesting in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
The information collection does not contain any questions of a sensitive nature.
Approximately 319,811 respondents take 3.5 minutes each to complete form SSA-721 each year. The total corresponding burden of 18,656 hours is reflected as burden hours, and we did not calculate a separate cost burden.
There is no known cost burden to the respondents.
The annual cost to the Federal Government is approximately $15,660.50. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.
Since SSA last cleared this collection in 2005, the number of respondents decreased from 729,761 to 319,811, for a total decrease of -409,950 respondents. Accordingly, the total burden decreased from 42,569 hours to 18,656 hours (for a total burden decrease of -23,913 hours). This decrease was caused by the implementation of the electronic EDR system (0960-0700), which allows funeral directors to report deaths quickly and electronically.
SSA will not publish the results of the information collection.
OMB granted SSA an exemption from the requirement to print the OMB approval expiration date on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis). OMB granted this exemption so SSA would not have to de-circulate otherwise useable editions of forms whose expiration date had been reached. In addition, SSA is avoiding Government waste because we will not have to destroy and reprint stocks of forms.
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
SSA is not using statistical methods for this information collection.
0960-0142 (SSA-721)
| File Type | application/msword |
| File Title | Supporting Statement for Form SSA-721 |
| Author | Teresa Robinson |
| Last Modified By | 666429 |
| File Modified | 2008-07-21 |
| File Created | 2008-07-21 |