OMB control number

Statement of Death by Funeral Director and State Death Match

OMB 0960-0142 · SSA.

OMB 0960-0142

The death of a beneficiary is an event that terminates the individual’s entitlement to Social Security benefits. As regulated, states must furnish death information to SSA to compare to SSA’s payment files. SSA employs two modalities for ensuring it efficiently receives accurate information regarding the deaths of SSA-insured workers and beneficiaries: (1) Form SSA–721, Statement of Death by Funeral Director; and (2) the Electronic Death Registration (EDR). SSA operates the State Death Match collections, which includes the EDR process for electronically reporting death records to SSA. The states furnish death certificate information to SSA via a manual registration process (the SSA-721), or via the EDR Registration Process. Both death match processes are automated electronic transfers between the states and SSA. This collection, via paper form SSA-721 or the EDR, allows for the funeral director or funeral home responsible for the individual’s burial or cremation to report the death to SSA. SSA uses this information for three purposes: (1) to establish proof of death for the insured worker; (2) to determine if the insured individual was receiving any pre-death benefits SSA needs to terminate; and (3) to ascertain which surviving family member is eligible for the lump-sum death payment or for other death benefits. The respondents for this information collection are funeral directors who handled death arrangements for the insured individuals, and the states’ bureaus of vital statistics.

The latest form for Statement of Death by Funeral Director and State Death Match expires 2027-07-31 and can be found here.

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OMB Details

Report of Death by Funeral Director

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-721Statement of Death by Funeral Directorwww.ssa.govForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.