Application for Lump-Sum Death Payment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-8 Application For Lump-Sum Death Payment	Form and Instruction	Modified	Available
Form SSA-8 Application for Lump-Sum Death Payment - Paper	Form and Instruction	Modified	Repair queued
Addendum - 0013 (Final).docx	Supplementary Document	Uploaded 2022-09-20	Repair queued
Supporting Statement - 0013 (Final).docx	Supporting Statement A	Uploaded 2022-09-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8890	Application for Lump-Sum Death Payment - Paper	Form and Instruction	Modified	Application For Lump-Sum Death Payment
8890	Application for Lump-Sum Death Payment - Paper	Form and Instruction	Modified
8890	Application for Lump-Sum Death Payment - Paper	Other-Revised PA & PRA Statements	Modified
44962	Application for Lump-Sum Death Payment--Modernized Claims System (MCS) & Preliminary Claims System (PCS)	Other-Internal Use Screens	Modified

ICR Details

OMB Control No: 0960-0013	ICR Reference No: 202204-0960-010
Status: Active	Previous ICR Reference No: 201904-0960-009
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Lump-Sum Death Payment
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/23/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2026	36 Months From Approved	06/30/2023
Responses	739,001	0	662,107
Time Burden (Hours)	734,212	0	99,407
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses Form SSA-8 to collect information we need to authorize payment of the lump-sum death payment (LSDP) to a widow, widower, or children of the deceased, as defined in Section 202(i) of the Act. Respondents complete the application for this one-time payment through use of the paper form, or personal interview with an SSA employee either via telephone, or in a field office. For all personal interviews (either telephone or in-person), we collect the information via our electronic Modernized Claim System (MCS) screens. When a respondent completes the paper Form SSA-8, they mail it back to SSA. Respondents are applicants for the LSDP.

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Authorizing Statute(s): US Code: 42 USC 402 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:
	87 FR 39153	06/30/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 57551	09/20/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Application for Lump-Sum Death Payment - Paper	SSA-8	Application For Lump-Sum Death Payment
Application for Lump-Sum Death Payment--Modernized Claims System (MCS) & Preliminary Claims System (PCS)

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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	739,001	662,107	0	0	76,894	0
Annual Time Burden (Hours)	734,212	99,407	0	0	634,805	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: When we last cleared this IC in 2019, the burden was 99,407 hours. However, we are currently reporting a burden of 110,946 hours. This change stems from an increase in the number of responses from 662,107 to 739,001. There is no change to the burden time per response. Although the number of respondents changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. Note: The total burden reflected in ROCIS is 734,212, while the burden cited in #12 of the Supporting Statement is 110,946. This discrepancy is because the ROCIS burden reflects the following components: field office and teleservice center waiting time + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

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Annual Cost to Federal Government: $3,303,420

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: 09/30/2022

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