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Federal forms, ICRs, and supporting documents

Information Collection

Notice Regarding Substitution of Party Upon Death of Claimant

IC 9191 under ICR 202107-0960-009 · OMB 0960-0288.

Documents and Forms
Document Name
Document Type
Form
Form
Other-Cover Letter
Other-Cover Letter
Form
Form
IC Document
IC Document
Information Collection (IC) Details

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Notice Regarding Substitution of Party Upon Death of Claimant
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1457(c)(4) 20 CFR 404.957(c)(4)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HA-539 Notice Regarding Substitution of Party Upon Death of Claimant HA-539 (revised).pdf No   Paper Only
Other-Cover Letter Cover Letter to the Family of the Deceased for Substituion for a Deceased Claimant - HA-539.pdf No   Paper Only

Income Security Survivor Compensation

 

4,000 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 4,000 0 0 0 0 4,000
Annual IC Time Burden (Hours) 333 0 0 0 0 333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-HA-539 HA-539 (current).pdf 07/30/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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