Application for Lump-Sum Death Payment - Paper

Application for Lump-Sum Death Payment

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.