Application for Lump-Sum Death Payment--MCS with Electronic Signature (Signature Proxy)

Application for Lump-Sum Death Payment

OMB: 0960-0013

IC ID: 44961

Documents and Forms
Document Name
Document Type
Other-Internal Use Screens
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Application for Lump-Sum Death Payment--MCS with Electronic Signature (Signature Proxy)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.390-404.392

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Internal Use Screens SSA-8-F4 MCS screens.pdf Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

278,825 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 278,825 0 0 0 0 278,825
Annual IC Time Burden (Hours) 41,824 0 0 0 0 41,824
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current MCS Screens MCS - current version.doc 02/05/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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