OMB control number
Statement of Reclamation Action
OMB 0960-0734 ยท SSA.
OMB 0960-0734
SSA uses Form SSA-1713 to collect information to determine if a Canadian bank is able to return erroneous payments, and to determine how and when it can return payments made after the death of a recipient who elects to have payments sent to Canada. Form SSA-1712 (or SSA-1712 CN) is the cover sheet SSA prepares to request return of a payment erroneously made after the death of the recipient. SSA sends Form SSA-1712 with Form SSA-1713. If the bank is the entity that reported the death via a returned payment, SSA does not request Forms SSA-1712 and SSA-1713. The respondents are Canadian financial institutions who received Social Security payments at recipients' request.
The latest form for Statement of Reclamation Action expires 2021-10-31 and is listed under ICR 201802-0960-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form SSA-1713 SSA-1713 - Statement of Reclamation Action | Form |
| Form SSA-1712 SSA-1712 - Notice of Reclamation | Form and Instruction |
 Supporting Statement - 0734.docx | Supporting Statement A |
| Addendum - 0734.docx | Supplementary Document |
 SSA-1713 - Statement of Reclamation Action |
Form |
| SSA-1712 - Notice of Reclamation |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201802-0960-006 | Revision of a currently approved collection | 2018-07-04 | Approved without change | |
| 201503-0960-003 | Revision of a currently approved collection | 2015-05-28 | Approved with change | |
| 201204-0960-014 | Revision of a currently approved collection | 2012-08-15 | Approved without change | |
| 200906-0960-003 | Revision of a currently approved collection | 2009-10-01 | Approved without change | |
| 200607-0960-013 | Existing collection in use without an OMB Control Number | 2006-08-22 | Approved with change |
OMB Details
SSA-1712 - Notice of Reclamation
Federal Enterprise Architecture: Income Security - General Retirement and Disability
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form SSA-1712 | Cover Letter -Notice of Reclamation (Canada Payments Made in USD) | Fillable Printable | Form and instruction |
| Form SSA-1712 CN | Cover Letter - Notice of Reclamation (Canada Payment Made in Canada) | Fillable Printable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.