Information Collection

Application for Lump-Sum Death Payment - Paper

IC 8890 under ICR 201603-0960-004 · OMB 0960-0013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0013 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8-F4 Application for Lump-Sum Death Payment - Paper	Form
SSA-8-F4 Application For Lump-Sum Death Payment SSA-8-F4 - Revised (Fillable).pdf	Form
SSA-8-F4 - Current.pdf Current SSA-8-F4	IC Document

IC Title:

Application for Lump-Sum Death Payment - Paper

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 404.390-404.392

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	SSA-8-F4	Application For Lump-Sum Death Payment	SSA-8-F4 - Revised (Fillable).pdf		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: 8,164

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,164	-21,186	29,350
Annual IC Time Burden (Hours)	1,361	-3,531	4,892
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-8-F4	SSA-8-F4 - Current.pdf	06/20/2016

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