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Form SSA-1724 | Claim For Amounts Due In The Case Of Deceased Beneficiary | Social Security Administration. A deceased beneficiary may have been due a Social Security payment and/or a Medicare Premium refund prior to or at the time of death.
- Claim for Amounts Due in the Case of a Deceased Social ...
The deceased may have been due a Social Security payment...
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A deceased beneficiary may have been due a Social Security...
- SSA - POMS: GN 02301.500 - Form SSA-1724 (Claim for Amounts ...
GN 02301.500 Form SSA-1724 (Claim for Amounts Due in the...
- Claim for Amounts Due in the Case of a Deceased Social ...
- Deceased Person’S Information
- Applicant’S Information
- Next of Kin Information
- Signature
- Privacy Act Notice
- Social Security Act
- Paperwork Reduction Act Statement
In this section, you’ll complete the deceased individual’s information. This includes the following information: 1. Printing the name of the deceased 2. Deceased’s Social Security Number 3. Date of death 4. State of residence If the decedent received benefits on another person’s record, print the name of that person.
In this section of the form, you’ll complete the information requested: 1. Print name of the applicant 2. Applicant’s relationship to deceased
The next of kin information takes up most of the form. It’s important to include ALL of the information as requested by the SSA. The Form SSA-1724 will give specific instructions on the required information. Omitting information outside of these instructions doesn’t necessarily change entitlement to unpaid benefits. However, omissions may impact pa...
The signature field is where the applicant states, under penalty of perjury, that they are eligible for the unpaid benefits and refunded premiums. Underneath the perjury declaration, the applicant will: 1. Sign their full name. 2. Current date 3. Telephone number (include area code) 4. Mailing address (house number and street, apartment number, PO ...
As a federal agency, the SSA is required to follow all applicable federal laws when it comes to the use of any person’s information. The Privacy Act Notice notifies you exactly what rules apply.
The Social Security Act authorizes the SSA to collect. information for the purpose of determining the beneficiary’s payment. Although providing this information is voluntary, the SSA may not be able to make the appropriate Social Security paymentor reimburse a beneficiary’s premiums without it. The Social Security Administration may also use this i...
This section states that this form meets the requirements of the Paperwork Reduction Act of 1995. Their time estimate to complete this formis 10 minutes.
The office is listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.
