Information Collection

Report of Deceased Individual's Social Security Record

IC 43711 under ICR 200905-0960-003 · OMB 0960-0665.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0665 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-711 Report of Deceased Individual's Social Security Record	Form and Instruction
SSA-711 Request for Deceased Individual's Social Security Record SSA-711 Paper.pdf	Form and Instruction

IC Title:

Report of Deceased Individual's Social Security Record

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 402.130

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-711	Request for Deceased Individual's Social Security Record	SSA-711 Paper.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200	-49,800	50,000
Annual IC Time Burden (Hours)	23	-5,810	5,833
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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