Application for Lump-Sum Death Payment--Modernized Claims System (MCS)

Application for Lump-Sum Death Payment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0013 can be found here:

Documents and Forms

Document Name Document Type
SSA-8-F4 MCS screens.pdf Other-Internal Use Screens
MCS - current version.doc Current MCS Screens IC Document

Information Collection (IC) Details

IC Title:	Application for Lump-Sum Death Payment--Modernized Claims System (MCS)	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 404.390-404.392

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Use Screens			SSA-8-F4 MCS screens.pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 557,650	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	557,650	278,825	278,825
Annual IC Time Burden (Hours)	83,648	37,177	46,471
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current MCS Screens	MCS - current version.doc	02/05/2010

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