Application for Lump-Sum Death Payment

ICR 201303-0960-013

OMB: 0960-0013

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2013-04-11
Supporting Statement A
2013-07-11
ICR Details
0960-0013 201303-0960-013
Historical Active 201002-0960-004
SSA
Application for Lump-Sum Death Payment
Revision of a currently approved collection   No
Regular
Approved without change 08/29/2013
Retrieve Notice of Action (NOA) 07/19/2013
  Inventory as of this Action Requested Previously Approved
08/31/2016 36 Months From Approved 09/30/2013
587,000 0 587,000
88,540 0 93,187
0 0 0

SSA uses Form SSA-8-F4 to collect information needed to authorize payment of the lump-sum death payment (LSDP) to a widow, widower, or children as defined in Section 202(i) of the Act. Respondents complete the application for this one-time payment via paper form, telephone, or during an in-person interview with SSA employees. Respondents are applicants for the LSDP.

US Code: 42 USC 402 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  78 FR 21181 04/11/2013
78 FR 39055 06/28/2013
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 587,000 587,000 0 0 0 0
Annual Time Burden (Hours) 88,540 93,187 0 -4,647 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
There has been a change in the public reporting burden, because we are combining the MCS/signature proxy collections, and each method had a different response time by a minute, which changed the reported burden hours. We no longer require signature proxy, because MCS are done through signature proxy attestation, unless the applicant prefers to provide a wet signature, therefore, we are combining the MCS/signature proxy collections.

$89,841
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/19/2013


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