Addendum to the Supporting Statement

Addendum to the Supporting Statement for Form SSA-1724

Claim for Amounts Due In The Case of a Deceased Beneficiary

20 CFR 404.503(b)

OMB No. 0960-0101

Terms of Clearance

TERMS OF CLEARANCE:

As agreed to in the 8/10/06 memo, SSA agrees to make the two

minor modifications to the form identified by OMB.

8/10/06 Memo:

  “Claim for Amount Due in the Case of a Deceased Beneficiary”

1. In the claimant’s address line (top of page 1), there is a comma missing between “city” and “state.”  In addition, these address lines do not seem to provide enough space to have someone fill in their full address information.  We suggest revising to provide more space.

We will add the missing comma between “city” and “state.”  In terms of revising the form to fit all address information, please be advised that SSA has never had complaints about that issue in the past.  However, if OMB requires that we make that change, we can do so at the next scheduled reprint.

As per the above Terms of Clearance, SSA has made the two changes indicated as of the first reprint subsequent to the 8/11/06 approval of the SSA-1724.

Revision to the Collection Instrument:

We have revised this form to:

1. Include a section for Direct Deposit information in the “Signature Of Applicant” section;

2. Changed the title of the form from “Claim For Amounts Due In The Case Of Deceased Beneficiary” to “…Of A Deceased Social Security Recipient” as the word “beneficiary” can be confusing to non-Social Security recipients.

3. Shortened Section 3 to remove blocks for “Child’s Present Name”, “Child’s Name At Birth”, and “Explanation”. Instead the applicant will add this information on a separate sheet of paper if applicable;

4. Included spacers for the deceased’s SSN;

5. Moved the Privacy Act Statement to the 2^nd page;

6. Changed “Print Name of Claimant” to “Print Name of Applicant”;

7. Removed “Print Address of Claimant” box for redundancy;

8. Changed “Claimant” to “Applicant” throughout the whole form for consistency (currently they are referred to as claimant on page 1 and applicant on page 2);

9. Rephrased the statement, “I am claiming amounts due…” to “This claim is being made on behalf of the family or estate of…” to be more encompassing which will help eliminate multiple forms being submitted by multiple family members;

10. Changed the word “Omit” to “Skip”.

11. Overall cosmetic changes so the applicant can more easily follow each section and know what information to put and where it should go on the form.

SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the first page of the form.