Information Collection

Deceased Individual's Social Security Records, SSA-711 (Paper Form)

IC 43711 under ICR 202405-0960-006 · OMB 0960-0665.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0665 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-711 Deceased Individual's Social Security Records, SSA-711 (Paper Form)	Form
Form SSA-711 Request for Deceased Individual's Social Security Record Deceased Individual's Social Security Records, SSA-711 (Paper Form)	Form
SSA-711 Request for Deceased Individual's Social Security Record SSA-711.pdf	Form
SSA-711 Request for Deceased Individual's Social Security Record SSA-711.pdf	Form

IC Title:

Deceased Individual's Social Security Records, SSA-711 (Paper Form)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 402.130

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	SSA-711			www.ssa.gov	No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200	0	200
Annual IC Time Burden (Hours)	193	70	123
Annual IC Cost Burden (Dollars)	5,800	5,800	0

Documents for IC

table that charts IC Documents
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.

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