Information Collection

Application for Lump-Sum Death Payment - Paper

IC 8890 under ICR 202204-0960-010 · OMB 0960-0013.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0013 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8 Application for Lump-Sum Death Payment - Paper	Form and Instruction
Revised PA & PRA Statements.pdf	Other-Revised PA & PRA Statements
Revised PA & PRA Statements.pdf	Other-Revised PA & PRA Statements
SSA-8 Application For Lump-Sum Death Payment SSA-8 - Revised.pdf	Form and Instruction
SSA-8 Application For Lump-Sum Death Payment SSA-8 - Revised.pdf	Form and Instruction
SSA-8 - Current.pdf SSA-8 - Current	IC Document
SSA-8 - Current.pdf SSA-8 - Current	IC Document

IC Title:

Application for Lump-Sum Death Payment - Paper

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 404.390-404.392

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-8	Application For Lump-Sum Death Payment	SSA-8 - Revised.pdf		Yes	No	Fillable Printable
Other-Revised PA & PRA Statements			Revised PA & PRA Statements.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,747

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	5,747	263	5,484
Annual IC Time Burden (Hours)	958	44	914
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-8 - Current	SSA-8 - Current.pdf	09/02/2022

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