Information Collection Request

Statement of Death by Funeral Director and State Death Match

ICR 202405-0960-001 · OMB 0960-0142 · Received in OIRA

Forms and Documents

Document Name	Status
Form SSA-721 Report of Death by Funeral Director Form and Instruction	Modified
Addendum - 0142.docx Supplementary Document	2024-05-09
Supporting Statement - 0142.docx Supporting Statement A	2024-05-09

IC Document Collections

IC ID	Document Title	Status
37956	Report of Death by Funeral Director Form and Instruction	Modified
256495	State Death Match - States Expected to Become EDR's within next 3 Year Other-Death Screen Images	Modified
256494	State Death Match - Electronic Death Registration (EDR) Other-Death Screen Images	Modified
256493	State Death Match - Manual - Non-EDR Other-Instructions and File Format for State's Use	Removed
256492	State Death Match - Manual - Non-EDR Records from EDR sites Other-ile Format for State's Use	Removed

ICR Details

Status	Received in OIRA
Agency/Subagency	SSA
OMB Control No	0960-0142
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202210-0960-006
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31