Form SSA-8, Application for Lump-Sum Death Payment Instructions

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This form contains 125 fields organized into 34 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Applicant Name
Applicant Name Text
Please provide your first name, middle initial, and last name.
Applicant Signature and Date
Applicant Full Name Text
Please provide your full name, including your first name, middle initial, and last name, as the signature of the applicant.
Signature Date Date
Please enter the date you are signing this form.
Claim Identification
Claimant Name Text
Enter the full name of the person making the claim.
Beneficiary Notice Control Number (BNC) Text
Enter the beneficiary notice control number.
Deceased's Name Text
Enter the full name of the deceased person, especially if their surname differs from the claimant's name. Fill only if 'Claimant Name' surname differs from claimant's name.
Depends on: Claimant Name
Privacy Act Statement. 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 an accurate and timely decision on any claim filed and may result in the loss of benefits. We will use the information you provide to authorize a one-time lump-sum death payment. We may also share your information for the following purposes, called routine uses: • To contractors and other Federal agencies, as necessary, for the purpose of assisting us in the efficient administration of our programs. We will disclose information under this routine use only in situations in which we may enter into a contractual or similar agreement to obtain assistance in accomplishing an SSA function relating to this system of records; and • To student volunteers, individuals working under a personal services contract, and other workers who technically do not have the status of Federal employees, when they are performing work for SSA, as authorized by law, and they need access to personally identifiable information in SSA records in order to perform their assigned agency functions. 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. Ay list of additional routine uses is available in our Privacy Act System of Records Notice (S O R N) 6 0-0 0 8 9, entitled Claims Folders System, as published in the Federal Register (F R) on October 31, 2019, at 84 F R 5 8 4 2 2. Additional information, and a full listing of all our S O R Ns, is available on our website at w w w.s s ay.g o v/privacy. 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 (S O R N) 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 S O R N s, is available on our website at w w w.s s ay.g o v/privacy Text
This section provides information about the Privacy Act Statement related to the collection and use of personal information for the SSA-8 form. It explains the legal basis for collecting this information, the voluntary nature of providing it, and the potential consequences of not providing it. It also details how the information may be used and shared, including routine uses and disclosures under the Privacy Act.
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3 5 0 7, 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 control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA's website at w w w.social security.g o v. Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-8 0 0-7 7 2-1 2 1 3 (T T Y 1-8 0 0-3 2 5-0 7 7 8). You may send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden to: SSA, 6 4 0 1 Security B l v d, Baltimore, M D 2 1 2 3 5-6 4 0 1. Send only comments relating to our time estimate or other aspects of this collection to this address, not the completed form Text
This section provides information about the Paperwork Reduction Act and instructions on where to send the completed form. It is not a field that requires user input.
You have reached the end of the form. If you tab out of this field you will return to the beginning of the form Text
This is an informational message indicating that you have reached the end of the form. No input is required.
Claim Receipt Details
Telephone Number for Questions/Reports Text
Provide the telephone number to call if you have a question or need to report something related to the claim.
Claimant Telephone Number Text
Provide your primary telephone number for contact regarding this claim.
SSA Office Text
Enter the name or identifier of the Social Security Administration office handling this claim.
Claim Received Date Date
Provide the date on which the claim was officially received.
Deceased's Earnings
Earnings During Year of Death Number
Enter the total amount the deceased earned from employment and self-employment during the year of their death.
Earnings Year Before Death Number
Enter the total amount the deceased earned from employment and self-employment in the year prior to their death.
Deceased's Foreign Social Security System Coverage
Yes Checkbox
Check this box if the deceased ever engaged in work that was covered under the social security system of a country other than the United States.
No Checkbox
Check this box if the deceased never engaged in work that was covered under the social security system of a country other than the United States.
Foreign Social Security Coverage Countries Text
Please list the countries where the deceased was covered under a foreign social security system. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Deceased's Information
Deceased's Name Text
Please provide the full name of the deceased wage earner or self-employed person.
Deceased's Social Security Number Text
Please enter the deceased's Social Security Number.
Deceased's Date of Birth Date
Please enter the deceased's date of birth.
Deceased's Date of Death Date
Please enter the date of death for the deceased.
Deceased's Place of Death Text
Please enter the city and state where the deceased passed away.
Deceased's Military Service Information
Yes Checkbox
Check this box if the deceased was in the active military or naval service (including Reserve or National Guard active duty or active duty for training) after September 7, 1939, and before 1968.
No Checkbox
Check this box if the deceased was NOT in the active military or naval service (including Reserve or National Guard active duty or active duty for training) after September 7, 1939, and before 1968.
Service Start Date Date
Provide the start date of the deceased's military service. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Service End Date Date
Provide the end date of the deceased's military service. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Deceased's Parent Support Status
Yes Checkbox
Check this box if there is a surviving parent or parents of the deceased who was receiving support from the deceased either at the time the deceased became disabled under the Social Security law or at the time of death.
No Checkbox
Check this box if there is no surviving parent or parents of the deceased who was receiving support from the deceased either at the time the deceased became disabled under the Social Security law or at the time of death.
Deceased's Prior Marriage Information
Prior Spouse's Name Text
Enter the full name of the deceased's prior spouse, including their maiden name if applicable. Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Prior Marriage Start Date Date
Enter the date the prior marriage began. Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Prior Marriage Start Location Text
Enter the city and state where the prior marriage began. Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Prior Marriage End Reason Text
Explain how the prior marriage ended (e.g., divorce, death of spouse). Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Prior Marriage End Date Date
Enter the date the prior marriage ended. Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Prior Marriage End Location Text
Enter the city and state where the prior marriage ended. Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Clergyman or public official Checkbox
Check this box if the deceased's prior marriage was performed by a clergyman or public official. Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Other Checkbox
Check this box if the deceased's prior marriage was performed by a method other than by a clergyman or public official, and provide details in the 'Remarks' section. Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Prior Spouse's Date of Birth Date
Enter the date of birth of the prior spouse. Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Prior Spouse Date of Death Date
If the prior spouse is deceased, enter their date of death. Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Prior Spouse's Social Security Number Text
Enter the Social Security Number of the prior spouse, or indicate if it is none or unknown. Fill only if 'Is the deceased survived by a spouse?' is 'No'
Depends on: No
Deceased's Railroad Industry Work History
Yes Checkbox
Check this box if the deceased worked in the railroad industry for 7 years or more.
No Checkbox
Check this box if the deceased did not work in the railroad industry for 7 years or more.
Deceased's Work Inability Information
Yes Checkbox
Check this box if the deceased was unable to work due to illness, injuries, or conditions at the time of death.
No Checkbox
Check this box if the deceased was able to work at the time of death, or if their inability to work was not due to illness, injuries, or conditions.
Date Unable to Work Date
Provide the date when the deceased became unable to work. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Details of Separation at Time of Death
(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 CheckBox
Indicate if the deceased was away from home at the time of death. Fill only if 'No' is 'No'.
Depends on: No
Surviving spouse CheckBox
Indicate if the surviving spouse was away from home at the time of death. Fill only if 'No' is 'No'.
Depends on: No
Date Last Home Date
Please provide the last date the deceased and surviving spouse lived at the same home. Fill only if 'No' is 'No'.
Depends on: No
Reason Absence Began Text
Please describe the reason why the absence of the deceased or surviving spouse from home began. Fill only if 'No' is 'No'.
Depends on: No
Reason Apart at Time of Death Text
Please describe the reason why the deceased and surviving spouse were apart at the time of death. Fill only if 'No' is 'No'.
Depends on: No
Nature of Illness or Disabling Condition Text
Please describe the nature of the illness or disabling condition if separation was due to such a reason. Fill only if 'No' is 'No'.
Depends on: No
Direct Deposit Payment Information
Routing Transit Number Text
Please enter the Routing Transit Number for your financial institution. Fill only if 'Enroll in Direct Express', 'Direct Deposit Refused' is 'No' for all.
Depends on: Enroll in Direct Express, Direct Deposit Refused
Account Number Text
Please enter your bank account number. Fill only if 'Enroll in Direct Express', 'Direct Deposit Refused' is 'No' for all.
Depends on: Enroll in Direct Express, Direct Deposit Refused
Checking Checkbox
Check this box if you want your payment to be directly deposited into a checking account. Fill only if 'Enroll in Direct Express', 'Direct Deposit Refused' is 'No' for all.
Depends on: Enroll in Direct Express, Direct Deposit Refused
Savings Checkbox
Check this box if you want your payment to be directly deposited into a savings account. Fill only if 'Enroll in Direct Express', 'Direct Deposit Refused' is 'No' for all.
Depends on: Enroll in Direct Express, Direct Deposit Refused
Enroll in Direct Express Checkbox
Check this box if you wish to enroll in the Direct Express payment program.
Direct Deposit Refused Checkbox
Check this box if you are refusing direct deposit for your payment.
Federal Agency Benefits
Yes Checkbox
Check this box if anyone, including the deceased, has received or expects to receive a benefit from any other federal agency. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
No Checkbox
Check this box if no one, including the deceased, has received or expects to receive a benefit from any other federal agency. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
First Surviving Child's Name
Surviving Child 1 Full Name Text
Please provide the full legal name of the first surviving child.
Surviving Child 2 Full Name Text
Please provide the full legal name of the second surviving child.
Form SSA-8 (12-2024) UF
Form SSA-8 (12-20 24) U F. Discontinue Prior Editions. Social Security Administration. APPLICATION FOR LUMP-SUM DEATH PAYMENT*. * This may serve as an application for insurance benefits payable under the Railroad Retirement Act. O M B Number 0 9 6 0-0 0 1 3. Page 1 of 4. I am applying for the lump sum death payment for which I am eligible under Section 202(i) 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 Text
This is a declaration that you are applying for the lump-sum death payment based on the deceased's Social Security record. Ensure you are eligible under Section 202(i) of the Social Security Act and submit this application within two years of the deceased's death.
Fourth Surviving Child's Name
Fourth Surviving Child's Name (First Column) Text
Provide the full name of the fourth surviving child being listed in the first column.
Fifth Surviving Child's Name (Second Column) Text
Provide the full name of the fifth surviving child being listed in the second column.
Mailing Address
Mailing Street Address Text
Enter your full mailing street address, including any apartment number, P.O. Box, or rural route.
City and State Text
Enter the city and state of your mailing address.
ZIP Code Text
Enter the ZIP code of your mailing address.
County of Residence Text
Enter the name of the county where you currently live, if applicable.
Marriage to Child's Other Parent
Spouse's Name Text
Please provide the full name of the deceased's spouse, including their maiden name if applicable.
Marriage Date Date
Please provide the date the marriage began.
Marriage City and State Text
Please provide the city and state where the marriage took place.
How Marriage Ended Text
Please describe how the marriage ended (e.g., divorce, annulment).
Marriage End Date Date
Please provide the date the marriage ended.
Marriage End City and State Text
Please provide the city and state where the marriage ended.
Marriage performed by: Clergyman or public official Checkbox
Indicate if the marriage was performed by a clergyman or public official by checking this box.
Other (Explain in "Remarks") Checkbox
Check this box if the marriage to the child's other parent was performed by someone other than a clergyman or public official, and provide an explanation in the "Remarks" section.
Spouse's Date of Birth Date
Please provide the spouse's date of birth.
Spouse's Date of Death Date
If the spouse is deceased, please provide their date of death.
Spouse's Social Security Number Text
Please provide the spouse's Social Security Number.
Prior Benefits Filing Status
Yes Checkbox
Check this box if you have previously filed for Social Security benefits on the deceased's earnings record.
No Checkbox
Check this box if you have not previously filed for Social Security benefits on the deceased's earnings record.
Prior Marriage Status of Surviving Spouse
Yes Checkbox
Check this box if you were married before your marriage to the deceased. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
No Checkbox
Check this box if you were not married before your marriage to the deceased. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
Remarks
Remarks Section Reference ID Text
Please provide the reference ID for this section of remarks, if applicable.
Remarks Explanation Text
Please provide any explanations or additional information that could not be included in previous sections of the form. Fill only if 'Other', 'Other', 'Other (Explain in "Remarks")', 'Yes', 'Other (Explain in "Remarks")' is 'Yes', any.
Depends on: Other, Other, Other (Explain in "Remarks"), Yes, Other (Explain in "Remarks")
Response Time
Expected Response Days Number
Enter the number of days within which you should expect to hear back regarding your application.
Second Surviving Child's Name
First Surviving Child's Full Name Text
Please enter the full name of the first surviving child.
Second Surviving Child's Full Name Text
Please enter the full name of the second surviving child.
Spouses' Living Arrangement at Time of Death
Yes Checkbox
Check this box if the deceased and the surviving spouse were living together at the same address when the deceased died. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
No Checkbox
Check this box if the deceased and the surviving spouse were not living together at the same address when the deceased died. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
Surviving Spouse Disability Information
Yes, currently disabled Checkbox
Check this box if you are currently disabled and unable to work, or if there was a period during the last 14 months when you were disabled and unable to work. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
No, not currently disabled Checkbox
Check this box if you are not currently disabled and unable to work, and have not been during the last 14 months. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
Date Became Disabled Date
Provide the date when the surviving spouse became disabled. Fill only if 'Yes, currently disabled' is 'Yes'.
Depends on: Yes, currently disabled
Surviving Spouse Information
Yes Checkbox
Check this box if the deceased is survived by a spouse.
No Checkbox
Check this box if the deceased is not survived by a spouse.
Spouse's Name Text
Enter the full name of the deceased's spouse, including their maiden name if applicable. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Date of Marriage Date
Provide the date the deceased's marriage began. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Place of Marriage Text
Enter the city and state where the marriage took place. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
How Marriage Ended Text
Describe how the marriage between the deceased and their spouse ended. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Date Marriage Ended Date
Provide the date the marriage between the deceased and their spouse ended. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Place Marriage Ended Text
Enter the city and state where the marriage between the deceased and their spouse ended. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Surviving Spouse Name and Address
Surviving Spouse Name and Address Text
Provide the full name and complete address of the surviving spouse. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
Surviving Spouse's Details (Marriage to Deceased)
Clergyman or public official Checkbox
Check this box if the marriage was performed by a clergyman or public official. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
Other Checkbox
Check this box if the marriage was performed by someone other than a clergyman or public official, and explain in the 'Remarks' section. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
Spouse's Date of Birth or Age Date
Enter the surviving spouse's date of birth or their age. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
Spouse's Social Security Number Text
Enter the Social Security Number of the surviving spouse. If unknown or none, please indicate. Fill only if 'Is the deceased survived by a spouse?' is 'Yes'
Depends on: Yes
Surviving Spouse's Prior Marriage Details
Prior Spouse's Name Text
Enter the full name of the spouse from this prior marriage, including their maiden name. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Prior Marriage Start Date Date
Provide the date when this prior marriage began. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Prior Marriage Start Location Text
Enter the city and state where this prior marriage began. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
How Prior Marriage Ended Text
Describe how this prior marriage concluded (e.g., divorce, death). Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Prior Marriage End Date Date
Provide the date when this prior marriage ended. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Prior Marriage End Location Text
Enter the city and state where this prior marriage ended. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Clergyman or public official Checkbox
Check this box if the surviving spouse's prior marriage was performed by a clergyman or a public official. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Other (Explain in "Remarks") Checkbox
Check this box if the surviving spouse's prior marriage was performed by a method other than a clergyman or public official, and provide an explanation in the 'Remarks' section. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Prior Spouse's Date of Birth Date
Enter the date of birth for the spouse from this prior marriage. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Prior Spouse's Date of Death Date
If the spouse from this prior marriage is deceased, provide their date of death. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Prior Spouse's Social Security Number Text
Enter the Social Security Number of the spouse from this prior marriage. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Telephone Number
Main Telephone Number Text
Please enter the main telephone number where you can be contacted during the day.
Area Code Text
Please enter the area code for the telephone number provided.
Third Surviving Child's Name
First Surviving Child's Full Name Text
Provide the full legal name of the first surviving child.
Second Surviving Child's Full Name Text
Provide the full legal name of the second surviving child.
Witnesses
Witness 1 Signature Text
Enter the full name of the first witness as their signature. Fill only if 'SIGNATURE OF APPLICANT' is signed by mark (X).
Depends on: Applicant Full Name
Witness 1 Address Text
Enter the full mailing address (including street, city, state, and ZIP code) for the first witness. Fill only if 'Witness 1 Signature' is filled.
Depends on: Witness 1 Signature
Witness 2 Signature Text
Enter the full name of the second witness as their signature. Fill only if 'SIGNATURE OF APPLICANT' is signed by mark (X).
Depends on: Applicant Full Name
Witness 2 Address Text
Enter the full mailing address (including street, city, state, and ZIP code) for the second witness. Fill only if 'Witness 2 Signature' is filled.
Depends on: Witness 2 Signature