Addendum to the Supporting Statement for 0960-0013

Addendum 0013.doc

Application for Lump-Sum Death Payment

Addendum to the Supporting Statement for 0960-0013

OMB: 0960-0013

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Addendum to Form SSA-8-F4,

Application For Lump-Sum Death Payment

20 CFR 404.390-404.392

OMB No. 0960-0013





Minor Revisions to the Collection Instrument


SSA is making the following revisions:


We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.


SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the first page of the form.

File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
Last Modified By889123
File Modified2013-04-11
File Created2013-04-11

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