Claim for Amounts Due in the Case of a Deceased Beneficiary

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-1724-F4 Claim for Amounts Due In The Case of a Deceased Beneficiary	Form and Instruction	Modified	Available
Form SSA-1724-F4 Claim for Amounts Due in the Case of a Deceased Beneficiary	Form and Instruction	Modified	Repair queued
Addendum - 0101.docx	Supplementary Document	Uploaded 2021-06-25	Available
Addendum - 0101.docx	Supplementary Document	Uploaded 2021-06-25	Missing upstream
Supporting Statement - 0101 (Final).docx	Supporting Statement A	Uploaded 2024-07-23	Available
Supporting Statement - 0101.docx	Supporting Statement A	Uploaded 2021-06-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43696	Claim for Amounts Due in the Case of a Deceased Beneficiary	Form and Instruction	Modified	Claim for Amounts Due In The Case of a Deceased Beneficiary
43696	Claim for Amounts Due in the Case of a Deceased Beneficiary	Form and Instruction	Modified
43696	Claim for Amounts Due in the Case of a Deceased Beneficiary	Other-Revised PA and PRA Statements	Modified

ICR Details

OMB Control No: 0960-0101	ICR Reference No: 202104-0960-003
Status: Active	Previous ICR Reference No: 201712-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Claim for Amounts Due in the Case of a Deceased Beneficiary
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/12/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/25/2021
Terms of Clearance: The agency made modifications to the Supporting Statement to provide additional detail regarding the policy associated with and operation of this information collection. The agency also revised the burden estimate in ROCIS. Prior to triannual renewal, the agency will allow for electronic submission of this information collection or will upload a separate document in which the agency provides a fact-specific justification for why this information collection cannot be signed and filed electronically and why this is consistent with the agency's commitments under Sec. 4 (k)(iii) and (iv) of E.O. 14058.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2027	36 Months From Approved	08/31/2024
Responses	250,000	0	250,000
Time Burden (Hours)	266,667	0	41,667
Cost Burden (Dollars)	0	0	0

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Abstract: Section 204(d) of the Act provides that if an individual dies before payment under Title II is complete, or before a Medicare premium refund is due, SSA will pay the amount due (including the amount of any check not negotiated) to people who meet specified qualifications under an order of priority. When a Social Security payment, or Medicare premium, was due to a deceased beneficiary at the time of death, and there is insufficient information in the file to identify the people entitled to the payment, or their addresses, SSA asks the surviving spouse, next of kin, or legal representative of the estate to complete Form SSA-1724, Claim for Amounts Due in the Case of a Deceased Beneficiary. SSA collects the information when a surviving child(ren), parent(s), or spouse is not already entitled to a monthly benefit on the same earnings record, or is not filing for a lump-sum death payment as a former spouse. SSA uses the information Form SSA-1724 provides to ensure proper payment of an underpayment due to a deceased beneficiary. The respondents are applicants for Title II underpayments or Medicare premium refunds owed to deceased beneficiaries.

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Authorizing Statute(s): US Code: 42 USC 404 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 17874	04/06/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 33007	06/23/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Claim for Amounts Due in the Case of a Deceased Beneficiary	SSA-1724-F4	Claim for Amounts Due In The Case of a Deceased Beneficiary

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	250,000	250,000	0	0	0	0
Annual Time Burden (Hours)	266,667	41,667	0	0	225,000	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are no changes to the public reporting burden. However, we updated the burden in ROCIS to include the 30-minute travel time to the field office, which increased the overall burden for this collection. *Note: The total burden reflected in ROCIS is 266,667, while the burden cited in #12 above is 41,667. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30 minute, one-way, drive burden. In contrast, the chart in #12 above reflects actual burden.

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Annual Cost to Federal Government: $1,444,631

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/25/2021

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