f) State Notification to SSA of Deceased Claimant

SSI Notice of Interim Assistance Reimbursement (IAR)

Documents and Forms

Document Name Document Type
eIAR - Internet Screens (Revised).pdf Other-Internet Screens
eIAR - Internet Screens (Current).pdf Current eIAR Screens IC Document

Information Collection (IC) Details

IC Title:	f) State Notification to SSA of Deceased Claimant	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 416.1920, 416.1922 20 CFR 416.1901-416.1902, 416.1904 20 CFR 416.1906, 416.1908, 416.1910

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			eIAR - Internet Screens (Revised).pdf		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: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current eIAR Screens	eIAR - Internet Screens (Current).pdf	10/06/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.