Ssa 8 Template

Form SSA-8 is an application for a lump-sum death payment from the Social Security Administration. This form allows eligible individuals to apply for benefits based on the Social Security record of a deceased wage earner or self-employed person. It is crucial to complete this application within two years of the wage earner's death to ensure eligibility for benefits.

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Table of Contents

The SSA-8 form is an important document for individuals seeking a lump-sum death payment from the Social Security Administration. This form is primarily used to apply for benefits related to the death of a wage earner or self-employed person under Title II of the Social Security Act. It is crucial to submit this application within two years of the deceased's passing to ensure eligibility. The form requires detailed information about both the deceased and the applicant, including names, Social Security numbers, dates of birth and death, and the deceased's work history. Additionally, it addresses the marital status of the deceased, information about surviving children, and any prior marriages. The SSA-8 form also includes sections that inquire about military service and previous applications for Social Security benefits. Completing this form accurately is essential for the timely processing of the claim, which can provide financial support to surviving family members during a difficult time.

Ssa 8 Sample

Form SSA-8 (01-2020) UF	OMB No. 0960-0013
Discontinue Prior Editions	OMB No. 0960-0013
Social Security Administration	Page 1 of 4

APPLICATION FOR LUMP-SUM DEATH PAYMENT*

I apply for all insurance benefits for which I am eligible under Title II (Federal Old-Age, Survivors, and Disability Insurance) of the Social Security Act, as presently amended, on the named deceased's Social Security record.

(This application must be filed within 2 years after the date of death of the wage earner or self-employed person.)

*This may also be considered an application for insurance benefits payable under the Railroad Retirement Act.

1.		(a) PRINT name of Deceased Wage Earner		FIRST NAME, MIDDLE INITIAL, LAST NAME
		or Self-Employed Person (herein referred
		to as the "deceased")
		(b) Check (X) one for the deceased		Male	Female

		(c) Enter deceased's Social Security Number

	2.	PRINT your name	FIRST NAME, MIDDLE INITIAL, LAST NAME

3.	Enter date of birth of deceased
	(Month, day, year)

4.	(a) Enter date of death
	(Month, day, year)
	(b) Enter place of death
	(City and State)
5.	(a) Did the deceased ever file an application for Social	Yes	No	Unknown
	Security benefits, a period of disability under	(If "Yes," answer	(If "No" or "Unknown," go on to
	Social Security, Supplemental Security Income, or	(If "Yes," answer	(If "No" or "Unknown," go on to
	hospital or medical insurance under Medicare?	(b) and (c).)	item 6.)
	(b) Enter name(s) of person(s) on whose Social	FIRST NAME, MIDDLE INITIAL, LAST NAME
	Security record(s) other application was filed.

(c)Enter Social Security Number(s) of person(s) named in

(b). (If unknown, so indicate)

6.ANSWER ITEM 6 ONLY IF THE DECEASED WORKED WITHIN THE PAST 2 YEARS.

(a)About how much did the deceased earn from employment AMOUNT

and self-employment during the year of death?	$
(b) About how much did the deceased earn the year	AMOUNT
before death?	$

7.ANSWER ITEM 7 ONLY IF THE DECEASED DIED PRIOR TO AGE 66 AND WITHIN THE PAST 4 MONTHS

(a) Was the deceased unable to work because of	Yes	No
(a) Was the deceased unable to work because of	(If "Yes," answer	(If "No," go on to item 8.)
illness, injuries or conditions at the time of death?	(If "Yes," answer	(If "No," go on to item 8.)
	(b).)

(b)Enter the date the deceased became unable to work (Month, day, year)

8.	(a) Was the deceased in the active military or naval	Yes	No
	service (including Reserve or National Guard active	(If "Yes," answer	(If "No," go on to item 9.)
	duty or active duty for training) after September 7,	(If "Yes," answer	(If "No," go on to item 9.)
	1939 and before 1968?	(b) and (c).)
	(b) Enter dates of service.	From: (Month, Year)	To: (Month, Year)
	(b) Enter dates of service.

	(c) Has anyone (including the deceased) received, or
	does anyone expect to receive, a benefit from any	Yes	No
	other Federal agency?
9.	Did the deceased work in the railroad industry for	Yes	No
	7 years or more?	Yes	No
	7 years or more?

Form SSA-8 (01-2020) UF							Page 2 of 4
10. (a) Did the deceased ever engage in work that was covered under the social					Yes	(If "Yes," answer (b).)
	security system of a country other than the United States?				No (If "No," go on to item 11.)
					No (If "No," go on to item 11.)
	(b) If "Yes," list the country(ies).
11.	(a) Is the deceased survived by a	spouse?					Yes	No
	If "Yes," enter information about the marriage at the time of death below. If "No," go on to						Yes	No
	item 11(b) if the deceased had prior marriages or item 12 if the deceased never married.
	Spouse's Name (including Maiden Name)		When (Month, day, year)	Where (Name of City and State)

	How marriage ended		When (Month, day, year)	Where (Name of City and State)

	Marriage performed by:		Spouse's date of birth (or age)	Spouse's Social Security Number (If
	Clergyman or public official		Spouse's date of birth (or age)	none or unknown, so indicate)
	Clergyman or public official			none or unknown, so indicate)
	Other (Explain in "Remarks")

(b)If the deceased had a prior marriage(s) that lasted at least 10 years, enter the information below. If the deceased married the same individual multiple times and the remarriage took place within the year immediately following the year of the divorce, and the combined period of marriage totaled 10 years or more, include the marriage. If no prior marriages or if information is unavailable, please indicate below.

Spouse's Name (including Maiden Name)	When (Month, day, year)	Where (Name of City and State)

How marriage ended	When (Month, day, year)	Where (Name of City and State)

Marriage performed by:	Spouse's date of birth (or age)	If spouse deceased, give date
Clergyman or public official	Spouse's date of birth (or age)	of death
Clergyman or public official		of death
Other (Explain in "Remarks")
Spouse's Social Security Number (If none or unknown, so indicate)

(c)If the deceased has a surviving child(ren) as defined in item 12 and the deceased was married to the child's mother or father but the marriage ended in divorce, enter information on the marriage if not already listed in 11(b). If no prior marriages or if information is unavailable, please indicate below.

	Spouse's Name (including Maiden Name)	When (Month, day, year)	Where (Name of City and State)

	How marriage ended	When (Month, day, year)	Where (Name of City and State)

	Marriage performed by:	Spouse's date of birth (or age)	If spouse deceased, give date
	Clergyman or public official	Spouse's date of birth (or age)	of death
	Clergyman or public official		of death
	Other (Explain in "Remarks")
	Spouse's Social Security Number (If none or unknown, so indicate)

12.	The deceased's surviving children (including natural children, adopted children, and stepchildren) or dependent
	grandchildren (including stepgrandchildren) may be eligible for benefits based on the earnings record of the deceased.
	List below ALL such children who are now or were in the past 12 months UNMARRIED and:
	• UNDER AGE 18 • AGE 18 TO 19 AND ATTENDING SECONDARY SCHOOL
	• AGE 18 OR OLDER WITH A DISABILITY THAT BEGAN BEFORE AGE 22
	(If none, write ''None.'')

	Full Name of Child		Full Name of Child

13.	Is there a surviving parent (or parents) of the deceased who	Yes	No
	was receiving support from the deceased either at the time	(If "Yes," enter the name and
	the deceased became disabled under the Social Security law	(If "Yes," enter the name and
	or at the time of death?	address of the parent(s) in "Remarks".)
14.	Have you filed for any Social Security benefits on the	Yes	No
	deceased's earnings record before?	Yes	No
	deceased's earnings record before?

NOTE: If there is a surviving spouse, continue with item 15. If not, skip items 15 through 18.

15.If you are not the surviving spouse, enter the surviving spouse's name and address here

Form SSA-8 (01-2020) UF			Page 3 of 4
16.	(a) Were the deceased and the surviving spouse living	Yes	No
	together at the same address when the deceased died?	(If "Yes," go on to item 17.)	(If "No," answer (b).)

(b)If either the deceased or surviving spouse was away from home (whether or not temporarily) when the deceased died, give the following:

	Who was away?	Deceased		Surviving spouse
	Date last home	Reason absence began			Reason they were apart at time of death

	If separated because of illness, enter
	nature of illness or disabling condition.
If you are the surviving spouse, and if you are under age 66, answer 17.
17.	(a) Are you so disabled that you cannot work or was there some period during the last 14							Yes	No
	months when you were so disabled that you could not work?							Yes	No
	months when you were so disabled that you could not work?
	(b) If ''Yes,'' enter the date you became disabled.						(Month, day, year)

Answer 18 ONLY if you are the surviving spouse.
18. Were you married before your marriage to the deceased? If yes, enter information about your								Yes	No
	prior marriage(s) that lasted at least 10 years or ended due to death of the spouse. If you							Yes	No
	divorced then remarried the same individual within the year immediately following the year of
	the divorce and the combined period of marriage totaled at least 10 years, include the marriage.
	If you need more space, use "Remarks" section on back page or attach a separate sheet.
	Spouse's Name (including Maiden Name)		When (Month, day, year)			Where (Name of City and State)

	How marriage ended		When (Month, day, year)			Where (Name of City and State)

	Marriage performed by:		Spouse's date of birth (or age)			If spouse deceased, give date
	Clergyman or public official		Spouse's date of birth (or age)			of death
	Clergyman or public official					of death
	Other (Explain in "Remarks")

Spouse's Social Security Number (If none or unknown, so indicate)

For additional information about survivor benefits see our publication at www.socialsecurity.gov.

Remarks: (You may use this space for any explanation. If you need more space, attach a separate sheet.)

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms, and it is true and correct to the best of my knowledge.

SIGNATURE OF APPLICANTDate (Month, day, year)

Signature (First name, middle initial, last name) (Write in ink)

Telephone Number(s) at Which You

May Be Contacted During the Day

(Area Code)

Mailing Address (Number and street, Apt. No., P.O. Box, or Rural Route)

City and State		ZIP Code	Enter Name of County (if any) in which you now live

Direct Deposit Payment Information (Financial Institution)
Routing Transit Number	Account Number				Checking	Enroll in Direct Express
					Savings	Direct Deposit Refused

Witnesses are required ONLY if this application has been signed by mark (X) above. If signed by mark (X), two
witnesses to the signing who know the applicant must sign below, giving their full addresses.
1. Signature of Witness				2. Signature of Witness

Address (Number and street, City, State, and ZIP Code)				Address (Number and street, City, State, and ZIP Code)

Form SSA-8 (01-2020) UF	Page 4 of 4
RECEIPT FOR YOUR CLAIM FOR THE SOCIAL SECURITY LUMP-SUM DEATH PAYMENT

TELEPHONE NUMBER TO CALL IF YOU HAVE A QUESTION OR SOMETHING TO REPORT

TELEPHONE NUMBER

SSA OFFICE

DATE CLAIM RECEIVED

RECEIPT FOR YOUR CLAIM

Your application for the lump-sum death payment has been received and will be processed as quickly as possible.

You should hear from us within days after you have given us all the information we requested. Some claims may take longer if additional information is needed.

In the meantime, if you change your mailing address, you should report the change.

Always give us your claim number when writing or telephoning about your claim.

If you have any questions about your claim, we will be glad to help you.

CLAIMANT

SOCIAL SECURITY CLAIM NUMBER

DECEASED'S NAME (If surname differs from claimant's name)

Privacy Act Statement - Application for Lump-Sum Death Payment

Collection and Use of Personal Information

Section 202 of the Social Security Act, as amended, allows us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent us from making an accurate and timely determination on any claim filed and could result in a loss of a Social Security Administration (SSA) provided benefit.

We will use the information to authorize our one-time disbursement of the lump-sum death payment to a widow, widower, or children as defined in Section 202. We may also share your information for the following purposes, called routine uses:

•Information may be disclosed to contractors and other Federal agencies, as necessary, for the purpose of assisting the SSA in the efficient administration of its programs. We contemplate disclosing information under this routine use only in situations in which SSA may enter a contractual or similar agreement with a third party to assist in accomplishing an agency function relating to this system of records; and

•To a congressional office in response to an inquiry from that office made at the request of the subject of a record.

In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.

A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0089, entitled Claims Folders Systems, as published in the Federal Register (FR) on April 1, 2003, at 68 FR 15784. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.

▼ Ssa 8 PDF Form

Document Attributes

Fact Name	Description
Purpose	The SSA-8 form is used to apply for a lump-sum death payment from Social Security for eligible beneficiaries.
Eligibility	Applications must be filed within two years of the wage earner's death to qualify for benefits.
Governing Law	The form operates under Title II of the Social Security Act and may also apply to the Railroad Retirement Act.
Information Required	Applicants need to provide details about the deceased, including their Social Security number, date of birth, and date of death.

Ssa 8: Usage Instruction

Filling out the SSA-8 form is an important step in applying for a lump-sum death payment from the Social Security Administration. It is essential to provide accurate and complete information to ensure that the application is processed smoothly. Following the steps below will help guide you through the process of filling out the form correctly.

Begin by entering the name of the deceased wage earner in the designated area. Include the first name, middle initial, and last name.
Check the box to indicate the deceased's gender, either Male or Female.
Input the deceased's Social Security number.
Provide your name, including your first name, middle initial, and last name.
Enter the deceased's date of birth in the format of month, day, and year.
Record the date of death in the same format as above and also enter the place of death, specifying the city and state.
Answer whether the deceased ever filed for Social Security benefits by checking Yes, No, or Unknown. If you answer Yes, provide the names and Social Security numbers of those who filed applications.
If the deceased worked within the past two years, indicate their earnings for the year of death and the year before death.
If the deceased died before age 66 and within the past four months, answer whether they were unable to work due to illness or injury. If Yes, provide the date they became unable to work.
Indicate whether the deceased served in the military after September 7, 1939, and before 1968. If Yes, provide the dates of service.
Answer if the deceased worked in the railroad industry for seven years or more.
Indicate if the deceased engaged in work covered under the social security system of another country. If Yes, list the countries.
Answer whether the deceased is survived by a spouse. If Yes, provide details about the marriage, including the spouse's name, date of marriage, and how the marriage ended.
If applicable, provide information about any prior marriages of the deceased that lasted at least ten years.
List any surviving children or dependent grandchildren who may be eligible for benefits.
Indicate if there is a surviving parent who was receiving support from the deceased at the time of death.
Answer whether you have filed for any Social Security benefits on the deceased's earnings record before.
If you are not the surviving spouse, enter the name and address of the surviving spouse.
Provide information about whether the deceased and the surviving spouse were living together at the time of death.
If you are the surviving spouse and under age 66, answer questions about your disability status.
Answer whether you were married before your marriage to the deceased, and provide details if applicable.
In the remarks section, include any additional information that may be necessary.
Sign and date the application, and provide your contact information, including your telephone number and mailing address.
If you signed by mark, ensure that two witnesses sign and provide their addresses.

Once you have completed the SSA-8 form, it is important to submit it promptly to the Social Security Administration. After submission, you can expect to receive communication regarding your claim. If you have any questions or need further assistance during this process, do not hesitate to reach out to the SSA for support.

Frequently Asked Questions

What is Form SSA-8?
Form SSA-8 is an application for a lump-sum death payment from the Social Security Administration (SSA). This form is used to apply for benefits for which the deceased may have been eligible under Title II of the Social Security Act. It can also serve as an application for benefits under the Railroad Retirement Act.
Who can apply using Form SSA-8?
Typically, the surviving spouse, children, or other eligible family members of the deceased wage earner can apply for the lump-sum death payment. The application must be submitted within two years of the date of the wage earner's death.
What information do I need to complete Form SSA-8?
To fill out Form SSA-8, you will need the following information:
- The deceased’s full name and Social Security number.
- The date and place of the deceased's death.
- Details about any previous Social Security benefits the deceased may have applied for.
- Information about the surviving spouse and children, if applicable.
- Any earnings information for the deceased within the last two years.
How long does it take to process the application?
After submitting Form SSA-8, you should expect to hear back from the SSA within a few days, provided all necessary information is included. However, some claims may take longer if additional information is required.
What happens if I miss the two-year deadline to file Form SSA-8?
If the application is not submitted within two years of the wage earner's death, you may lose the opportunity to receive the lump-sum death payment. It's important to file the application as soon as possible to avoid this situation.
Can I check the status of my application?
Yes, you can check the status of your application by contacting the Social Security Administration directly. Be sure to have your claim number handy when you call, as this will help them assist you more efficiently.
Is there a way to receive the payment directly into my bank account?
Yes, you can choose to have your lump-sum death payment deposited directly into your bank account by providing your banking information on the form. This can expedite the receipt of your benefits.

Common mistakes

Filling out the SSA-8 form can be a daunting task, especially during a time of loss. One common mistake people make is not providing accurate information about the deceased's Social Security number. This number is crucial for identifying the deceased's record. If it is incorrect or missing, it can delay the processing of the application significantly. Always double-check the number to ensure it matches the records.

Another frequent error involves overlooking the deadline for filing the application. The SSA-8 must be submitted within two years of the wage earner's death. Failing to meet this deadline can result in the denial of benefits. It is essential to keep track of the date of death and ensure the application is filed promptly.

Many applicants also struggle with incomplete information regarding prior marriages. If the deceased had previous marriages, it is important to provide details about those unions, especially if they lasted at least ten years. Missing this information can complicate the application process, as it may affect the eligibility of surviving spouses or children for benefits.

Another mistake often made is not answering all the relevant questions. Each section of the form is designed to gather specific information. If a question does not apply, it is best to indicate that clearly, rather than leaving it blank. This helps prevent confusion and ensures that the application is processed without unnecessary delays.

Finally, applicants sometimes forget to sign and date the form before submission. A missing signature can render the application invalid, requiring the applicant to start the process all over again. It is a simple step, but one that is easily overlooked in the midst of everything else going on during such a challenging time.

Documents used along the form

The SSA-8 form is an important document used to apply for a lump-sum death payment from the Social Security Administration. When completing this form, there are several other documents that may also be required or helpful to have on hand. Below is a list of some common forms and documents that are often used alongside the SSA-8.

Death Certificate: This official document verifies the date and cause of death. It is typically required to process the SSA-8 application.
Social Security Card of the Deceased: The deceased's Social Security card can help confirm their Social Security number, which is needed for the SSA-8 form.
Proof of Relationship: Documents such as marriage certificates or birth certificates may be necessary to establish the relationship between the applicant and the deceased.
Tax Returns: Recent tax returns of the deceased may be requested to verify income and work history, especially if the deceased worked in the last two years.
Military Service Records: If the deceased served in the military, these records can provide proof of service, which may affect eligibility for benefits.
Prior Benefit Applications: If the deceased had previously filed for Social Security or other benefits, copies of these applications can be useful for reference.
Direct Deposit Information: If the applicant wishes to receive payments via direct deposit, bank account details will be needed to complete the process.

Gathering these documents can help ensure that the SSA-8 application is processed smoothly and efficiently. It is advisable to check with the Social Security Administration for any specific requirements or additional forms that may be needed based on individual circumstances.

Similar forms

Form SSA-1: This is an application for retirement benefits. Like Form SSA-8, it requires personal information about the applicant and the deceased, including Social Security numbers and dates of birth.
Form SSA-4: This form is used to apply for benefits as a surviving spouse. It shares similarities with Form SSA-8 in that both require information about the deceased and the relationship to the applicant.
Form SSA-5: This is a request for a child's benefits. Similar to Form SSA-8, it focuses on the deceased's relationship to the applicant and includes details about the deceased's earnings.
Form SSA-7: This form is for applying for widow’s or widower’s benefits. It, too, asks for information about the deceased's work history and marital status, much like Form SSA-8.
Form SSA-10: This is an application for a lump-sum death payment for children. It parallels Form SSA-8 by addressing eligibility for benefits based on the deceased's earnings record.
Form SSA-11: This form is used to apply for benefits as a representative payee. It requires similar information regarding the deceased's Social Security record and benefits eligibility.
Form SSA-16: This application is for disability benefits. Like Form SSA-8, it requires detailed personal information and may involve the deceased's work history.
Form SSA-20: This form is used for applying for Medicare. It shares some commonalities with Form SSA-8 in terms of needing the deceased’s Social Security number and other personal details.
Form SSA-21: This is a request for information about work history. It is similar to Form SSA-8 as it collects information regarding the deceased's employment and earnings.

Dos and Don'ts

When filling out the SSA-8 form, it is essential to follow specific guidelines to ensure accuracy and completeness. Below are eight important do's and don'ts to consider:

Do print clearly and legibly to avoid any misunderstandings.
Do provide the deceased's Social Security number accurately.
Do answer all questions completely, even if you feel some information is not applicable.
Do check the form for errors before submitting it.
Don't leave any required fields blank; this could delay processing.
Don't use abbreviations or shorthand; clarity is crucial.
Don't forget to sign and date the application before submission.
Don't submit the form without including any necessary supporting documents.

Misconceptions

Misconception 1: The SSA-8 form is only for immediate family members.

This form can be completed by anyone eligible to apply for the lump-sum death payment, not just immediate family members. Friends or distant relatives may also apply if they meet the necessary criteria.

Misconception 2: You must apply for the SSA-8 form within one year of the deceased's death.

The application must be filed within two years after the date of death. This allows more time for individuals to gather necessary information and complete the form.

Misconception 3: The SSA-8 form is only applicable to Social Security benefits.

This form may also be considered an application for benefits under the Railroad Retirement Act. Therefore, it is not limited solely to Social Security benefits.

Misconception 4: You cannot apply if the deceased had prior marriages.

Prior marriages do not disqualify an applicant from receiving benefits. Information about previous marriages is required to determine eligibility for benefits based on the deceased's earnings record.

Misconception 5: You need to provide extensive documentation with the SSA-8 form.

Misconception 6: The SSA-8 form guarantees a payment.

Filing the SSA-8 form does not guarantee that a payment will be issued. The Social Security Administration will review the application and determine eligibility based on the provided information.

Key takeaways

The SSA-8 form is used to apply for a lump-sum death payment from Social Security, which must be filed within two years of the wage earner's death.
Applicants must provide the deceased's full name, Social Security number, date of birth, and date of death, as well as the place of death.
Information regarding any previous applications for Social Security benefits by the deceased must be disclosed, including the names and Social Security numbers of individuals involved.
Details about the deceased's earnings from employment or self-employment during the year of death and the previous year must be included.
If applicable, the form requires information about the deceased's military service and any benefits received from other federal agencies.
The applicant must indicate whether the deceased has surviving family members, such as a spouse or children, who may be eligible for benefits.
Completing the SSA-8 form accurately is crucial, as incorrect or missing information can delay the processing of the claim.