Information Collection

Application for Lump-Sum Death Payment - Internet Screens (UBA Platform)

IC 281192 under ICR 202603-0960-003 · OMB 0960-0013.

Documents and Forms

Document Name Document Type
UBA Internet Screens - LSDP (SSA-8).pdf www.ssa.gov (UBA Platform) Other-Internet Screens

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Lump-Sum Death Payment - Internet Screens (UBA Platform)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.390-404.392

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			UBA Internet Screens - LSDP (SSA-8).pdf	www.ssa.gov (UBA Platform)	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,864	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,864	6,864
Annual IC Time Burden (Hours)	2,174	2,174
Annual IC Cost Burden (Dollars)	0	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.

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