Information Collection

f) State Notification to SSA of Deceased Claimant

IC 186512 under ICR 201107-0960-007 · OMB 0960-0546.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0546 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	f) State Notification to SSA of Deceased Claimant	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1920, 416.1922 20 CFR 416.1901-416.1902, 416.1904 20 CFR 416.1906, 416.1908, 416.1910

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

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