Report of Death by Funeral Director

Statement of Death by Funeral Director

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0142 can be found here:

Documents and Forms

Document Name Document Type
Updated PA and PRA Statements - SSA-721.pdf Other-Revised Privacy Act and PRA St
SSA-721 Statement of Death by Funeral Director SSA-721 - Revised Version.pdf Form and Instruction
SSA-721 - Current Version.pdf Current Version of the SSA-721 IC Document

Information Collection (IC) Details

IC Title:	Report of Death by Funeral Director	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.715 20 CFR 404.720

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Revised Privacy Act and PRA Statements			Updated PA and PRA Statements - SSA-721.pdf		No		Fillable Printable
Form and Instruction	SSA-721	Statement of Death by Funeral Director	SSA-721 - Revised Version.pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 703,638	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	703,638	383,827	319,811
Annual IC Time Burden (Hours)	46,909	25,588	21,321
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current Version of the SSA-721	SSA-721 - Current Version.pdf	05/02/2017

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