Information Collection

Claim for Amounts Due in the Case of a Deceased Beneficiary

IC 43696 under ICR 201511-0960-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Claim for Amounts Due In The Case of a Deceased Beneficiary Claim for Amounts Due in the Case of a Deceased Beneficiary	Form and Instruction
SSA-1724-F4 Claim for Amounts Due In The Case of a Deceased Benefici SSA-1724-F4 - (Revised).pdf	Form and Instruction
SSA-1724-F4 - (Current - 01-29-10).pdf Claim for Amounts Due in the Case of a Deceased Beneficiary	IC Document

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				Yes	No	Fillable Printable

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
Claim for Amounts Due in the Case of a Deceased Beneficiary		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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