Information Collection

Report of Death by Funeral Director

IC 37956 under ICR 202210-0960-006 · OMB 0960-0142.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0142 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-721 Report of Death by Funeral Director	Form and Instruction
SSA-721 Statement of Death by Funeral Director SSA-721 (revised).pdf	Form and Instruction
SSA-721 Statement of Death by Funeral Director SSA-721 (revised).pdf	Form and Instruction
SSA-721 (current).pdf Current Version of the SSA-721	IC Document
SSA-721 (current).pdf Current Version of the SSA-721	IC Document

IC Title:

Report of Death by Funeral Director

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.715 20 CFR 404.720

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-721	Statement of Death by Funeral Director	SSA-721 (revised).pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 544,233

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	544,233	544,233
Annual IC Time Burden (Hours)	36,282	36,282
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current Version of the SSA-721	SSA-721 (current).pdf	10/20/2020

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