Information Collection

Deceased Individual's Social Security Records, SSA-711 (Paper Form)

IC 43711 under ICR 202107-0960-001 · OMB 0960-0665.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0665 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-711 Deceased Individual's Social Security Records, SSA-711 (Paper Form)	Form
SSA-711 Request for Deceased Individual's Social Security Record SSA-711 - Revised Version.pdf	Form
SSA-711 Request for Deceased Individual's Social Security Record SSA-711 - Revised Version.pdf	Form
SSA-711 - Current Version.pdf Current SSA-711	IC Document
SSA-711 - Current Version.pdf Current SSA-711	IC Document

IC Title:

Deceased Individual's Social Security Records, SSA-711 (Paper Form)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 402.130

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	SSA-711	Request for Deceased Individual's Social Security Record	SSA-711 - Revised Version.pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	200	0	200
Annual IC Time Burden (Hours)	123	100	23
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-711	SSA-711 - Current Version.pdf	09/10/2021

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