Addendum to the Supporting Statement for 0960-0013

Addendum to Supporting Statement for Form SSA-8

Application For Lump-Sum Death Payment

20 CFR 404.390-404.392

OMB No. 0960-0013

Revisions to the Collection Instrument

SSA is making the following revisions:

• Change #1: SSA is updating the language in Question 5(a) on Page 1 of Form SSA-8 to the following:

1. Did the deceased ever file an application for Social Security benefits, a period of disability under Social Security, Supplemental Security Income, or hospital or medical insurance under Medicare?

Justification #1: SSA is revising this language to be consistent with other forms for Social Security, Supplemental Security Income, or Medicare benefits.

• Change #2: SSA is revising the language in the first block of Question 11(a) on Page 2 to the following:

1. Is the deceased survived by a spouse?

If “Yes,” enter information about the marriage at the time of death below. If “No,” go on to item 11(b) if the deceased had prior marriages or item 12 if the deceased never married.

Justification #2: SSA is revising this language to provide easier readability and clarity for applicants.

• Change #3: SSA is revising the language in the first block of Question 11(b) on Page 2 to the following:

2. If the deceased had a prior marriage(s) that lasted at least 10 years, enter the information below. If the deceased married the same individual multiple times and the remarriage took place within the year immediately following the year of the divorce, and the combined period of marriage totaled 10 years or more, include the marriage. If no prior marriages or if information is unavailable, please indicate below.

Justification #3: SSA is revising the language in Question 11(b) to provide easier readability and clarity for applicants.

• Change #4: SSA is revising the language in the first block of Question 11(c) to the following:

If the deceased has a surviving child(ren), as defined in item 12, and the deceased was married to the child’s mother or father but the marriage ended in divorce, enter information on the marriage if not already listed in 11(b). If no prior marriages or if information is unavailable, please indicate below.

Justification #4: SSA is revising the language in Question 11(c) to provide easier readability and clarity for applicants.

• Change #5: SSA is revising the language in Question 12 on Page 2 of the form to the following:

The deceased’s surviving children (included natural children, adopted children, and stepchildren) or dependent grandchildren (including stepgrandchildren) may be eligible for benefits based on the earnings record of the deceased.

List below ALL such children who are now or were in the past 12 months UNMARRIED and:

• UNDER AGE 18

• AGE 18 TO 19 AND ATTENDING SECONDARY SCHOOL

• AGE 18 OR OLDER WITH A DISABILITY THAT BEGAN BEFORE AGE 22

(If none, write “None.”)

Justification #5: SSA is revising the language in Question 12 to conform to the wording in the amendment to Section 504 of the Rehabilitation Act in 1992. In 1992, an amendment to Section 504 of the Rehabilitation Act corrected the terminology in the Act. The amendment replaced the term “disabled” with the term “persons with disabilities” due to its negative impact. This wording is also consistent with phrasing used in Social Security Administration publications.

• Change #6: SSA is adding the direct deposit information field on Page 3 under the “City and State,” “Zip Code,” and “Enter Name of County (if any) in which you now live” field.

Justification #6: SSA is adding the Direct Deposit Payment Information (Financial Institution) field to provide applicants the opportunity to receive their payment electronically via direct deposit in their financial institution. SSA is also adding this field to ensure that all electronic versions of SSA forms are consistent.

• Change #7: We are revising the Privacy Act Statement on this form.

Justification #7: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the form.

We will make these revisions upon OMB’s approval of this request.

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