Information Collection Request
Statement of Death by Funeral Director and State Death Match
ICR 202405-0960-001 · OMB 0960-0142 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form SSA-721 Report of Death by Funeral Director |
Form and Instruction | Modified | Available |
 Addendum - 0142.docx |
Supplementary Document | Uploaded 2024-05-09 | Repair queued |
| Supporting Statement - 0142.docx |
Supporting Statement A | Uploaded 2024-05-09 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 37956 |  Report of Death by Funeral Director |
Form and Instruction | Modified | |
| 256495 | State Death Match - States Expected to Become EDR's within next 3 Year |
Other-Death Screen Images | Modified | |
| 256494 | State Death Match - Electronic Death Registration (EDR) |
Other-Death Screen Images | Modified | |
| 256493 | State Death Match - Manual - Non-EDR |
Other-Instructions and File Format for State's Use | Removed | |
| 256492 | State Death Match - Manual - Non-EDR Records from EDR sites |
Other-ile Format for State's Use | Removed |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | SSA |
| OMB Control No | 0960-0142 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202210-0960-006 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |