Information Collection

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

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

Documents and Forms

Document Name Document Type
Form SSA-711 Deceased Individual's Social Security Records, SSA-711 (Paper Form) Form
SSA-711 Request for Deceased Individual's Social Security Record SSA-711.pdf www.ssa.gov Form

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-711	Request for Deceased Individual's Social Security Record	SSA-711.pdf	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 %

	Requested	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

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.