Claim for Amounts Due in the Case of a Deceased Beneficiary

Claim for Amounts Due in the Case of a Deceased Beneficiary

OMB: 0960-0101

IC ID: 43696

Information Collection (IC) Details

View Information Collection (IC)

Claim for Amounts Due in the Case of a Deceased Beneficiary
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.503 (b)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-1724-F4 Claim for Amounts Due In The Case of a Deceased Beneficiary SSA-1724-F4 - (Revised).pdf Yes No Fillable Printable

Income Security General Retirement and Disability

 

250,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 250,000 0 0 0 0 250,000
Annual IC Time Burden (Hours) 41,667 0 0 0 0 41,667
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Claim for Amounts Due in the Case of a Deceased Beneficiary SSA-1724-F4 - (Current - 01-29-10).pdf 11/17/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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