Application for Lump-Sum Death Payment--Modernized Claims System (MCS)

Application for Lump-Sum Death Payment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0013 can be found here:

Documents and Forms

Document Name Document Type
SSA-8-F4 MCS screens.pdf Other-Internal Use Screens
PCS Screen Package.pdf Other-Intranet Screens
PCS Privacy Act Statement.pdf Other-Updated Privacy Act Statement

Information Collection (IC) Details

IC Title:	Application for Lump-Sum Death Payment--Modernized Claims System (MCS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.390-404.392

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Use Screens	SSA-8-F4 MCS screens.pdf	Yes	Yes	Fillable Fileable
Other-Intranet Screens	PCS Screen Package.pdf	Yes	Yes	Fillable Fileable Signable
Other-Updated Privacy Act Statement for the PCS Screens	PCS Privacy Act Statement.pdf	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 662,084	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	662,084	662,084
Annual IC Time Burden (Hours)	99,313	99,313
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.