Information Collection

Claim for Amounts Due in the Case of a Deceased Beneficiary

IC 43696 under ICR 201712-0960-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-1724-F4 Claim for Amounts Due in the Case of a Deceased Beneficiary Form and Instruction
SSA-1724-F4 Privacy Act Statemeny (revised).doc Other-Privacy Act Statement 0101 (re
SSA-1724-F4 Claim for Amounts Due In The Case of a Deceased Benefici SSA-1724 (revised).pdf Form and Instruction
SSA-1724 (current).pdf Claim for Amounts Due in the Case of a Deceased Beneficiary IC Document

Information Collection (IC) Details

View Information Collection (IC)

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:

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 (revised).pdf		Yes	No	Fillable Printable
Other-Privacy Act Statement 0101 (revised)			SSA-1724-F4 Privacy Act Statemeny (revised).doc		Yes	No	Paper Only

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 %

	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

Title	Document	Date Uploaded
Claim for Amounts Due in the Case of a Deceased Beneficiary	SSA-1724 (current).pdf	02/07/2018

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