Information Collection

Notice Regarding Substitution of Party Upon Death of Claimant

IC 9191 under ICR 201507-0960-008 · OMB 0960-0288.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0288 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HA-539 Notice Regarding Substitution of Party Upon Death of Claimant	Form
HA-539 Notice Regarding Substitution of Party Upon Death of Cla HA-539 Revised Version.pdf	Form
HA-539 Current Version.docx HA-539 Current Version	IC Document

IC Title:

Notice Regarding Substitution of Party Upon Death of Claimant

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 416.1457(c)(4) 20 CFR 404.957(c)(4)

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	HA-539	Notice Regarding Substitution of Party Upon Death of Claimant	HA-539 Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,000

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	4,000	4,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HA-539 Current Version	HA-539 Current Version.docx	07/14/2015

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