Information Collection

Claim for Amounts Due in the Case of a Deceased Beneficiary

IC 43696 under ICR 201204-0960-012 · OMB 0960-0101.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0101 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1724-f4 (revis Claim for Amounts Due in the Case of a Deceased Beneficiary	Form and Instruction
SSA-1724-f4 (revis Claim for Amounts Due In The Case of a Deceased Social S SSA-1724 (Revised).pdf	Form and Instruction
SSA-1724 (current).pdf CLAIM FOR AMOUNTS DUE IN THE CASE OF A DECEASED SOCIAL SECURITY RECIPIENT	IC Document

IC Title:

Claim for Amounts Due in the Case of a Deceased Beneficiary

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 404.503 (b)

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-1724-f4 (revised)	Claim for Amounts Due In The Case of a Deceased Social Security Recipient	SSA-1724 (Revised).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250,000

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	Previously Approved
Annual Number of Responses for this IC	250,000	250,000
Annual IC Time Burden (Hours)	41,667	41,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CLAIM FOR AMOUNTS DUE IN THE CASE OF A DECEASED SOCIAL SECURITY RECIPIENT	SSA-1724 (current).pdf	07/16/2012

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