Report of Death by Funeral Director

Statement of Death by Funeral Director and State Death Match

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.