Supporting Statement for Form SSA-721
Statement of Death by Funeral Director
20 CFR 404.715 and 404.720
OMB No. 0960-0142
Introduction/Authoring Laws and Regulations
Section 202(d) of the Social Security Act and section 20 CFR 404.715 of the Code of Federal Regulations mandate the requirement for the Social Security Administration (SSA) to provide death benefit payments to the appropriate surviving family member when an SSA-insured worker dies. 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 the SSA-721, Statement of Death by Funeral Director, to obtain a funeral director’s confirmation of death for an SSA-covered individual.
Description of Collection
When an SSA-insured worker dies, the funeral director or funeral home responsible for the worker’s burial or cremation completes the SSA-721 and sends it to SSA. SSA uses 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 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. The respondents are funeral directors who handled death arrangements for the insured individuals.
Use of Information Technology to Collect the Information
SSA has not created a directly corresponding electronic version of form SSA-721 under the Government Paperwork Elimination Act plan. However, funeral directors can use SSA’s Internet-based collection instrument, the Electronic Death Registry (OMB No. 0960-0700), to electronically submit similar information to SSA.
Why We Cannot Use Duplicate Information
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 similar data to the data we are collecting here (an electronic exception is 0960-0700; see #3, above, for details).
Minimizing Burden on Small Respondents
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. In addition, SSA employees collect this information only once from the respondent to avoid undue burden on the funeral homes and directors.
Consequence of Not Collecting Information or Collecting it Less Frequently
If SSA did not conduct this information collection, the agency would lose a valuable source confirming insured individuals’ deaths, which would affect the issuance of death benefits and the termination of other benefits the individual received prior to 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.
Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on March 3, 2010 at 76 FR 11835, and SSA received no public comments. The second Notice published on May 26, 2011 at 76 FR 30749. If we receive any comments in response to the 30-day Notice, we will forward them to OMB. SSA did not consult members of the public in the development or maintenance of this form.
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects 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.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Approximately 319,811 respondents take 3.5 minutes each to complete the SSA-721 each year for 18,656 annual burden hours. This figure represents burden hours, and we did not calculate a separate cost burden.
Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $15,660. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information.
Program Changes or Adjustments to the Information Collection Request
There are no changes to the public reporting burden.
Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since 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 destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
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 does not use statistical methods for this information collection.
| File Type | application/msword |
| File Title | Supporting Statement for Form SSA-721 |
| Author | Teresa Robinson |
| Last Modified By | 889123 |
| File Modified | 2011-05-26 |
| File Created | 2011-05-26 |