Statement of Death by Funeral Director and State Death Match

ICR 202210-0960-006

OMB: 0960-0142

Federal Form Document

Forms and Documents
Form and Instruction
Justification for No Material/Nonsubstantive Change
Supporting Statement A
ICR Details
0960-0142 202210-0960-006
Received in OIRA 202008-0960-005
Statement of Death by Funeral Director and State Death Match
No material or nonsubstantive change to a currently approved collection   No
Regular 10/21/2022
  Requested Previously Approved
05/31/2024 05/31/2024
128,021,190 544,233
36,282 36,282
257,449,861 0

When an SSA-insured worker dies, the funeral director or funeral home responsible for the worker’s burial or cremation completes Form SSA-721 and sends it to SSA. SSA uses this information for three purposes: (1) to establish proof of death for the insured worker; (2) to determine if the insured individual was receiving any pre-death benefits SSA needs to terminate; and (3) to ascertain which surviving family member is eligible for the lump-sum death payment or for other death benefits. The respondents are funeral directors who handled death arrangements for the insured individuals. We are making a non-substantive change to combine State Death Match (OMB NO. 0960-0700) with Statement of Death by Funeral Director (OMB No. 0960-0142), under this OMB Control Number, as per OMB's Terms of Clearance on both of these ICRs.

US Code: 42 USC 402 Name of Law: Social Security Act

Not associated with rulemaking

  85 FR 45723 07/29/2020
85 FR 63630 10/08/2020

  Total Request 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 128,021,190 544,233 0 127,476,957 0 0
Annual Time Burden (Hours) 36,282 36,282 0 0 0 0
Annual Cost Burden (Dollars) 257,449,861 0 0 257,449,861 0 0

Faye Lipsky 410 965-8783 [email protected]


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:
    (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;
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.

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