State Death Match - Electronic Death Registration (EDR)

Statement of Death by Funeral Director and State Death Match

Documents and Forms

Document Name Document Type
Death Screen Images.pdf www.ssa.gov Other-Death Screen Images
Death Screen Images.pdf www.ssa.gov Other-Death Screen Images

Information Collection (IC) Details

IC Title:	State Death Match - Electronic Death Registration (EDR)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.371 20 CFR 404.301 20 CFR 404.310-404.311 20 CFR 404.316 20 CFR 404.330-404.341 20 CFR 404.350-404.352 20 CFR 404.715 20 CFR 404.720 20 CFR 416.912

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Death Screen Images			Death Screen Images.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	170,881,758	47,331,870	123,549,888
Annual IC Time Burden (Hours)	42,720,440	42,720,440	0
Annual IC Cost Burden (Dollars)	473,342,470	220,065,200	253,277,270

Documents for IC

Title	Document	Date Uploaded
No associated records found

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