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Deceased Individual's Social Security Records, SSA-711 (Paper Form)
Report of Deceased Individual's Social Security Record
OMB: 0960-0665
IC ID: 43711
OMB.report
SSA
OMB 0960-0665
ICR 202405-0960-006
IC 43711
( )
Documents and Forms
Document Name
Document Type
Form SSA-711
Deceased Individual's Social Security Records, SSA-711 (Paper Form)
Form
SSA-711 Request for Deceased Individual's Social Security Record
SSA-711.pdf
www.ssa.gov
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Deceased Individual's Social Security Records, SSA-711 (Paper Form)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
20 CFR 402.130
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-711
Request for Deceased Individual's Social Security Record
SSA-711.pdf
www.ssa.gov
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
200
0
0
0
0
200
Annual IC Time Burden (Hours)
193
0
0
70
0
123
Annual IC Cost Burden (Dollars)
5,800
0
0
5,800
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.
