Information Collection

Claim for Amounts Due in the Case of a Deceased Beneficiary

IC 43696 under ICR 201501-0960-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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.pdf	Form and Instruction

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.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
No associated records found

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