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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1724-F4 Claim for Amounts Due in the Case of a Deceased Beneficiary	Form and Instruction
Form SSA-1724-F4 Claim for Amounts Due In The Case of a Deceased Beneficiary Claim for Amounts Due in the Case of a Deceased Beneficiary	Form and Instruction
SSA-1724 - Revised PA and PRA Statements.pdf	Other-Revised PA and PRA Statements
SSA-1724 - Revised PA and PRA Statements.pdf	Other-Revised PA and PRA Statements
SSA-1724-F4 Claim for Amounts Due In The Case of a Deceased Benefici SSA-1724 - Revised Version.pdf	Form and Instruction
SSA-1724-F4 Claim for Amounts Due In The Case of a Deceased Benefici SSA-1724 - Revised Version.pdf	Form and Instruction
SSA-1724 - Current Version.pdf Current SSA-1724	IC Document
SSA-1724 - Current Version.pdf Current SSA-1724	IC Document

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1724-F4				Yes	No	Fillable Printable
Other-Revised PA and PRA Statements					Yes	No	Printable 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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	250,000	0	250,000
Annual IC Time Burden (Hours)	266,667	225,000	41,667
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-1724		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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