Information Collection

Request for Deceased Individual's Social Security Record

IC 189491 under ICR 201206-0960-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
SSA-711 - Revised Internet Version.pdf	Other-Electronic Submission
SSA-711 - Current Internet Version.pdf Current Internet SSA-711	IC Document

IC Title:

Request for 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
Other-Electronic Submission			SSA-711 - Revised Internet Version.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 49,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	49,800	49,800
Annual IC Time Burden (Hours)	5,810	5,810
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current Internet SSA-711	SSA-711 - Current Internet Version.pdf	07/17/2012

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