Supporting Statement for Form SSA-8-F4
Application For Lump-Sum Death Payment
20 CFR 404.390-404.392
OMB No. 0960-0013
A. Justification
Introduction/Authoring Laws and Regulations
Title II of the Social Security Act (Act) provides for payment of a lump-sum death payment (not to exceed $255) upon the death of an insured individual. Section 202(i) of the Act explains the conditions of eligibility for this payment, including the filing of an application. Regulations at 20 CFR 404.390-404.392 of the Code of Federal Regulations set the procedures and policies for implementing Section 202(i) of the Act. 20 CFR 404.392 requires the filing of an application by individual applicants to collect the information needed to determine eligibility for the payment. The SSA-8-F4 elicits the information about the applicant and the relationship to the deceased needed to make this determination of eligibility.
Description of Collection
The Social Security Administration (SSA) uses Form SSA-8-F4 to collect information needed to authorize payment of the lump-sum death payment (LSDP) to a widow, widower, or children as defined in Section 202(i) of the Act. Respondents complete the application for this one-time payment via paper form, telephone, or during an in-person interview with SSA employees. Respondents are applicants for the LSDP.
Use of Information Technology to Collect the Information
SSA collects the same information on the paper Form SSA-8-F4 as we collect electronically using SSA’s Modernized Claims System (MCS) during an interview (telephone or in person). MCS is an internal electronic forms system available to SSA claims representatives. In accordance with the agency’s Government Paperwork Elimination Act plan, we estimate claims representatives take approximately 95% of the applications electronically. In addition, SSA created an Intranet version of Form SSA-8-F4. The Intranet version allows the respondents to complete the form electronically using a personal computer, or other computing device, print the completed form, and mail it to SSA. We developed these electronic versions, as we want to ensure SSA provides effective communication and remains in compliance with the requirements of 45 CFR 85.51 of the Code of Federal Regulations and section 504 of the Rehabilitation Act of 1973.
Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we collect it precludes duplication. SSA does not use another collection instrument to obtain similar data.
Minimizing Burden on Small Respondents
This collection does not significantly affect small businesses or other small entities.
6. Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Form SSA-8-F4, we would have no way to determine eligibility for LSDP, and would be unable to authorize payments to the widow, widower, or children of the deceased beneficiary. Because we collect the information on an as needed basis, we cannot collect it less frequently. There are no technical or legal obstacles that prevent burden reduction.
7. Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
SSA published the 60-day advance Federal Register Notice on April 4, 2016 at 81 FR 19283, and we did not receive any public comments in response to this notice. We published the 30-day Federal Register Notice on June 20, 2016 at 81 FR 39990. If we receive any comments in response to the 30-day Notice, we will forward them to OMB. We did not consult with the public in the maintenance of this form.
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Estimated Total Annual Burden (hours) |
MCS |
662,084 |
1 |
9 |
99,313 |
Paper |
8,164 |
1 |
10 |
1,361 |
Total |
670,248 |
|
|
100,674 |
The total burden for this ICR is 100,674 hours. This figure represents burden hours, and we did not calculate a separate cost burden.
Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal government is approximately $89,841. This estimate is a projection of printing and distribution costs for the information collection, and for collecting the information.
15. Program Changes or Adjustments to the Information Collection Request
The change in the public reporting burden stems from combining the MCS and signature proxy collections. Since each method had a different response time by a minute, which changed the reported burden hours. We no longer require separate burden for our MCS collections, because we complete all MCS claims through signature proxy attestation, unless the applicant prefers to provide a wet signature. Therefore, we are combining the MCS and signature proxy collections.
16. Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
17. Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms, (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise usable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Title of Information Collection and Form Number(s) |
| Author | Naomi |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |