OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Claim for Amounts Due in the Case of a Deceased Beneficiary

IC 43696 under ICR 202104-0960-003 · OMB 0960-0101.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Other-Revised PA and PRA Statements
Other-Revised PA and PRA Statements
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Claim for Amounts Due in the Case of a Deceased Beneficiary
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.503 (b)

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 Version.pdf Yes No Fillable Printable
Other-Revised PA and PRA Statements SSA-1724 - Revised PA and PRA Statements.pdf Yes No Printable Only

Income Security General Retirement and Disability

 

250,000 0
   
Individuals or Households
 
   0 %

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

Title Document Date Uploaded
Current SSA-1724 SSA-1724 - Current Version.pdf 06/25/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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