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View ICR - Agency Submission

OMB Control No: 0960-0013	ICR Reference No: 202603-0960-003
Status: Received in OIRA	Previous ICR Reference No: 202204-0960-010
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Lump-Sum Death Payment
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 06/26/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	785,323	739,001
Time Burden (Hours)	1,097,935	734,212
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	785,323	739,001	6,864	39,458
Annual Time Burden (Hours)	1,097,935	734,212	2,174	361,549
Annual Cost Burden (Dollars)	0	0	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2023, the burden was 110,946 hours. However, we are currently reporting a burden of 387,622 hours. This change stems from an increase in the number of responses from 739,001 to 785,323. In addition, we also included the new Internet screens through the UBA platform which is a new method for respondents to submit the information that increases the overall burden for this information collection. These figures represent current MI data. NOTE: The total burden reflected in ROCIS is 1,097,935, while the burden cited in #12 of the Supporting Statement is 387,622. This discrepancy is because the ROCIS burden reflects the following components: field office and teleservice center waiting time + a rough estimate of a 30-minute, one-way, drive burden + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

Annual Cost to Federal Government: $3,675,239

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

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