Addendum to the Supporting Statement for 0960-0013

Addendum to Supporting Statement for Form SSA-8-F4

Application For Lump-Sum Death Payment

20 CFR 404.390-404.392

OMB No. 0960-0013

Revisions to the Collection Instrument

SSA is making the following revisions:

• Change #1: SSA intends to provide Form SSA-8-F4 in a fillable PDF file on our website, in place of the non-fillable PDF version we currently provide. We propose to make all form entries fillable.

Justification #1: This change will allow the respondents to continue to print and complete the form by hand, or, alternatively, complete the form using a computing device, such as a personal computer or handheld (mobile) device, print, and submit the form to SSA for processing.

• Change #2: Page 2: Question number 11(a). Line 3, we are correcting the misspelled word.

From:

(a) Is the deceased survived by a spouse? If "Yes", enter information about the marriage in effect at the time of death below. If "No", go on to item 11(b) if the deceased had prior marraiges or item 12 if the deceased never married.

To:

1. Is the deceased survived by a spouse? If "Yes", enter information about the marriage in effect at the time of death below. If "No", go on to item 11(b) if the deceased had prior marriages or item 12 if the deceased never married.

Justification #2: We corrected the spelling of the word: marriages.

• Change #3: Page 2: Question 11(c). We need to remove a period at the end of the sentence.

From:

(c) If the deceased has surviving children as defined in item 12 and he or she was married to the child's mother or father but the marriage ended in divorce, enter information on the marriage if not already listed in 11(b)..

If none or unknown, so indicate.

To:
c) If the deceased has surviving children as defined in item 12 and he or she was married to the child's mother or father but the marriage ended in divorce, enter information on the marriage if not already listed in 11(b).

If none or unknown, so indicate.

Justification #3: We edited the sentence to remove a period at the end of the sentence.

• Change #4: Page 3: Question 16. Last line in bold. We need to change the word “If” to lower case.

From:

If you are the surviving spouse, and If you are under age 66, answer 17.

To:

If you are the surviving spouse, and if you are under age 66, answer 17.

Justification #4: We edited the sentence to change the word “If” to lower case.

• Change #5: Page 3: Under “Signature of Applicant,” we are bolding the statement: “Write in ink.”

From:

Signature (First name, middle initial, last name) (Write in ink)

To:

Signature (First name, middle initial, last name) (Write in ink)

Justification #5: We bolded the statement to emphasize the instruction to use ink.