Statement of Death by Funeral Director

Forms and Documents

Document Name	Status
Form SSA-721 Report of Death by Funeral Director Form and Instruction	Modified
0960-0142 Addendum 2008.doc Supplementary Document	2008-07-21
0960-0142 supporting statement 2008.DOC Supporting Statement A	2008-07-21

IC Document Collections

IC ID	Document Title	Status
37956	Report of Death by Funeral Director Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0142	ICR Reference No: 200807-0960-005
Status: Historical Active	Previous ICR Reference No: 200509-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement of Death by Funeral Director
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/11/2008
	Date Received in OIRA: 07/22/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2011	36 Months From Approved	09/30/2008
Responses	319,811	0	729,761
Time Burden (Hours)	18,656	0	42,569
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses the information on Form SSA-721 to make timely and accurate decisions based on the report of death including: 1) to prove the death of an insured individual, 2) to learn of the death of a beneficiary whose benefits should terminate, and 3) to determine who is eligible for the Lump-Sum Death Payment (LSDP) or may be eligible for benefits. The respondents are funeral directors who handled death arrangements for the insured individuals.

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Authorizing Statute(s): US Code: 42 USC 402 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 22989	04/28/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 37524	07/01/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Report of Death by Funeral Director	SSA-721	Statement of Death by Funeral Director

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	319,811	729,761	0	-409,950	0	0
Annual Time Burden (Hours)	18,656	42,569	0	-23,913	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The decrease in the number of respondents (and therefore burden hours) is attributed to the increased use of the automated Electronic Death Registry instead.

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Annual Cost to Federal Government: $15,660

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/22/2008

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