This form contains 125 fields organized into 37 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Applicant Name
1. PRINT your name. FIRST NAME, MIDDLE INITIAL, LAST NAME	Text	Enter your full name, including first name, middle initial, and last name, as the applicant for the lump-sum death payment.
Applicant Signature and Contact
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 APPLICANT (First name, middle initial, last name) (Write in ink). Ay wet signature is required. Complete the form, print and sign	Text	Sign the form to declare that all information provided is true and correct to the best of your knowledge. A wet signature is required.
Date (MM/DD/YYYY)	Date	Enter the date when you are signing the form in MM/DD/YYYY format.
Telephone Number(s) at Which You May Be Contacted During the Day. Area Code	Text	Provide the area code of the telephone number(s) where you can be contacted during the day.
Telephone Number	Text	Enter the telephone number where you can be contacted during the day.
Claimant and BNC Numbers
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	Text	Enter the full name of the claimant applying for the lump-sum death payment. This is the person who is making the claim based on the deceased's Social Security record.
BENEFICIARY NOTICE CONTROL NUMBER (B N C)	Text	Provide the Beneficiary Notice Control Number (BNC). This is a unique identifier for your claim and is used for tracking and reference purposes.
Current Marriage Information (10a)
10. (ay) Is the deceased survived by a spouse? Yes. If "Yes," enter information about the marriage at the time of death below	CheckBox	Indicate if the deceased is survived by a spouse. Select 'Yes' and provide information about the marriage at the time of death if applicable.
No. If "No," go on to item 10(b) if the deceased had prior marriages or item 11 if the deceased never married	CheckBox	Check this box if the deceased had no prior marriages. If checked, proceed to item 10(b) if the deceased had prior marriages or item 11 if the deceased never married.
Spouse's Name (including Maiden Name)	Text	Enter the full name of the deceased's spouse, including the maiden name if applicable.
When (M M/D D/Y Y Y Y)	Date	Enter the date when the marriage took place in the format MM/DD/YYYY.
Where (Name of City and State)	Text	Enter the name of the city and state where the marriage took place.
How marriage ended	Text	Describe how the marriage ended (e.g., divorce, death).
When (M M/D D/Y Y Y Y)	Date	Enter the date when the marriage ended in the format MM/DD/YYYY.
Where (Name of City and State)	Text	Enter the name of the city and state where the marriage ended.
Marriage performed by: Clergyman or public official	CheckBox	Check this box if the marriage was performed by a clergyman or public official.
Other (Explain in "Remarks")	CheckBox	Check this box if the marriage was performed by someone other than a clergyman or public official and explain in the 'Remarks' section.
Spouse's date of birth (or age)	Text	Enter the date of birth or age of the deceased's spouse.
Spouse's Social Security Number (If none or unknown, please indicate)	Text	Enter the Social Security Number of the deceased's spouse. If none or unknown, please indicate.
Deceased Earnings Last Two Years
5. ANSWER ITEM 5 ONLY IF THE DECEASED WORKED WITHIN THE PAST 2 YEARS. (ay) About how much did the deceased earn from employment and self-employment during the year of death? AMOUNT	Number	If the deceased worked within the past 2 years, enter the approximate amount they earned from employment and self-employment during the year of death.
(b) About how much did the deceased earn the year before death? AMOUNT	Number	Enter the approximate amount the deceased earned from employment and self-employment in the year before their death.
Deceased Name
DECEASED'S NAME (If surname differs from claimant's name)	Text	Enter the full name of the deceased individual. If the deceased's surname is different from the claimant's, ensure to specify it here.
Deceased Personal Details
2. (ay) PRINT name of Deceased Wage Earner or Self-Employed Person (herein referred to as the "deceased"). FIRST NAME, MIDDLE INITIAL, LAST NAME	Text	Enter the full name of the deceased wage earner or self-employed person, including first name, middle initial, and last name.
(b) Enter deceased's Social Security Number	Text	Enter the Social Security Number of the deceased person.
3. Enter date of birth of deceased (M M/D D/Y Y Y Y)	Date	Enter the date of birth of the deceased in the format MM/DD/YYYY.
4. (ay) Enter date of death (M M/D D/Y Y Y Y)	Date	Enter the date of death of the deceased in the format MM/DD/YYYY.
(b) Enter place of death (City and State)	Text	Enter the place of death, specifying the city and state where the deceased passed away.
Direct Deposit Information
Direct Deposit Payment Information (Financial Institution). Routing Transit Number	Text	Provide the routing transit number of your financial institution for direct deposit of the payment.
Account Number	Text	Enter the bank account number where you want the lump-sum death payment to be deposited.
Checking	CheckBox	Check this box if the bank account is a checking account.
Savings	CheckBox	Check this box if the bank account is a savings account.
Enroll in Direct Express	CheckBox	Check this box if you wish to enroll in Direct Express for receiving the payment.
Direct Deposit Refused	CheckBox	Check this box if you refuse to use direct deposit for receiving the payment.
First Child Names
11. 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 elementary or secondary school (grade 12 or below) full time OR • Age 18 or older with a disability that began before age 22. (If none, write ''None.''). Full name of first child	Text	List the full name of the first child who is eligible for benefits based on the deceased's earnings record. Include natural, adopted, stepchildren, or dependent grandchildren who meet the eligibility criteria.
Full name of fifth child	Text	List the full name of the fifth child who is eligible for benefits based on the deceased's earnings record.
First Prior Marriage Details
Spouse's Name (including Maiden Name)	Text	Enter the full name of your spouse, including their maiden name if applicable.
When (M M/D D/Y Y Y Y)	Date	Enter the date of the marriage in the format MM/DD/YYYY.
Where (Name of City and State)	Text	Enter the name of the city and state where the marriage took place.
How marriage ended	Text	Describe how the marriage ended (e.g., divorce, death).
When (M M/D D/Y Y Y Y)	Date	Enter the date when the marriage ended in the format MM/DD/YYYY.
Where (Name of City and State)	Text	Enter the name of 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. Check if applicable.
Other (Explain in "Remarks")	CheckBox	Indicate if the marriage was performed by someone other than a clergyman or public official. Provide an explanation in the 'Remarks' section if applicable.
Spouse's date of birth (or age)	Text	Enter the date of birth or age of the deceased's spouse. This information is required to verify eligibility for benefits.
If spouse deceased, give date  of death	Date	If the spouse of the deceased is also deceased, provide the date of their death. This helps determine eligibility for benefits.
Spouse's Social Security Number (If none or unknown, please indicate)	Text	Enter the Social Security Number of the deceased's spouse. If it is not known or does not exist, please indicate that.
First Prior Marriage Information (10b)
(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)	Text	Enter the full name of the deceased's prior spouse if the marriage lasted at least 10 years. Include maiden name if applicable. If no prior marriages or information is unavailable, please indicate.
When (M M/D D/Y Y Y Y)	Date	Enter the date when the prior marriage took place in the format MM/DD/YYYY.
Where (Name of City and State)	Text	Enter the name of the city and state where the prior marriage took place.
How marriage ended	Text	Specify how the marriage ended, such as divorce, annulment, or death.
When (M M/D D/Y Y Y Y)	Date	Enter the date when the marriage ended in the format MM/DD/YYYY.
Where (Name of City and State)	Text	Provide the name of the city and state where the marriage ended.
Marriage performed by: Clergyman or public official	CheckBox	Check this box if the marriage was performed by a clergyman or public official.
Other (Explain in "Remarks")	CheckBox	Check this box if the marriage was performed by someone other than a clergyman or public official and explain in the 'Remarks' section.
Spouse's date of birth (or age)	Text	Enter the spouse's date of birth or age.
If spouse deceased, give date  of death	Date	If the spouse is deceased, provide the date of death.
Spouse's Social Security Number (If none or unknown, please indicate)	Text	Enter the spouse's Social Security Number. If it is unknown or the spouse does not have one, please indicate.
Foreign Covered Work
Page 2 of 4. 9. (ay) Did the deceased ever engage in work that was covered under the social security system of a country other than the United States? Yes (If "Yes," answer (b).)	CheckBox	Indicate if the deceased ever worked in a job covered by the social security system of a country other than the United States. Select 'Yes' if applicable.
No (If "No," go on to item 10.)	CheckBox	Select 'No' if the deceased never worked in a job covered by the social security system of a country other than the United States.
(b) If "Yes," list the country(ies)	Text	If the deceased worked in a job covered by a foreign social security system, list the countries where this work took place.
Fourth Child Names
Full name of fourth child	Text	List the full name of the fourth child who is eligible for benefits based on the deceased's earnings record.
Full name of eighth child	Text	List the full name of the eighth child who is eligible for benefits based on the deceased's earnings record.
Information
For additional information about survivor benefits see Publication Number 0 5-1 0 0 8 4 at w w w.social security.g o v	Text	This field provides a reference to additional information about survivor benefits. Visit the provided website for more details.
Internal Reference Code
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.
Living Together at Time of Death
Page 3 of 4. 15. (ay) Were the deceased and the surviving spouse living together at the same address when the deceased died? Yes. (If "Yes," go on to item 16.)	CheckBox	Indicate if the deceased and the surviving spouse were living together at the same address at the time of death.
No. (If "No," answer (b).)	CheckBox	Indicate if the deceased and the surviving spouse were not living together at the same address at the time of death.
Mailing Address
Mailing Address (Number and street, Apartment number, P.O. Box, or Rural Route)	Text	Provide your complete mailing address, including street number, apartment number, P.O. Box, or rural route.
City and State	Text	Enter the city and state of your current residence.
ZIP Code	Text	Enter the ZIP code of your current residence.
Enter Name of County (if any) in which you now live	Text	Enter the name of the county where you currently reside, if applicable.
Military Service and Other Federal Benefits
7. (ay) Was the deceased 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? Yes (If "Yes," answer (b) and (c).)	CheckBox	Indicate if the deceased was in active military or naval service, including Reserve or National Guard, after September 7, 1939, and before 1968. Select 'Yes' if applicable.
NO (If "No," go on to item 8.)	CheckBox	Select 'No' if the deceased was not in active military or naval service after September 7, 1939, and before 1968.
(b) Enter dates of service. From: (m m/y y y y)	Date	Enter the start date of the deceased's military service in the format MM/YYYY.
To: (M M/Y Y Y Y)	Date	Enter the end date of the deceased's military service in the format MM/YYYY.
(c) Has anyone (including the deceased) received, or does anyone expect to receive, a benefit from any other Federal agency? Yes	CheckBox	Indicate if anyone, including the deceased, has received or expects to receive a benefit from any other Federal agency. Select 'Yes' if applicable.
No	CheckBox	Select 'No' if no one, including the deceased, has received or expects to receive a benefit from any other Federal agency.
OMB Control Number
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.
Page Identifier
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.
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.
Prior Marriage Indicator
Answer item 17 ONLY if you are the surviving spouse. 17. Were you married before your marriage to the deceased? If yes, enter information about your prior marriage(s) that lasted at least 10 years or ended due to death of the spouse. If you 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. Yes	CheckBox	Indicate if you were married before your marriage to the deceased. Check 'Yes' if applicable and provide details of prior marriages that lasted at least 10 years or ended due to the death of the spouse.
No	CheckBox	Indicate if you were not married before your marriage to the deceased. Check 'No' if applicable.
Prior Social Security Claim Question
13. Have you filed for any Social Security benefits on the deceased's earnings record before? Yes	CheckBox	Indicate if you have previously filed for any Social Security benefits on the deceased's earnings record.
No	CheckBox	Indicate if you have not previously filed for any Social Security benefits on the deceased's earnings record.
Railroad Industry Work
8. Did the deceased work in the railroad industry for 7 years or more? Yes	CheckBox	Indicate if the deceased worked in the railroad industry for 7 years or more. Select 'Yes' if applicable.
No	CheckBox	Select 'No' if the deceased did not work in the railroad industry for 7 years or more.
Remarks
Remarks: (You may use this space for any explanation. If you need more space, attach a separate sheet.)	Text	Use this space to provide any additional explanations or remarks related to your application. Attach a separate sheet if more space is needed.
Response Time Days Field
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 blank days after you have given us all the information we requested. Some claims may take longer if additional information is needed. Amount of days you should hear from us after you have given us all the information we requested	Text	Enter the number of days you should expect to hear back from the SSA after providing all requested information.
Second Child Names
Full name of second child	Text	List the full name of the second child who is eligible for benefits based on the deceased's earnings record.
Full name of sixth child	Text	List the full name of the sixth child who is eligible for benefits based on the deceased's earnings record.
Second Prior Marriage Information (10c)
(c) If the deceased has a surviving child(ren) as defined in item 11 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 10(b). If no prior marriages or if information is unavailable, please indicate below. Spouse's Name (including Maiden Name)	Text	Provide the name of the spouse, including maiden name, if the deceased was married to the child's mother or father and the marriage ended in divorce.
When (M M/D D/Y Y Y Y)	Date	Enter the date when the marriage began in the format MM/DD/YYYY.
Where (Name of City and State)	Text	Provide the name of the city and state where the marriage took place.
How marriage ended	Text	Specify how the marriage ended, such as divorce, annulment, or death.
When (M M/D D/Y Y Y Y)	Date	Enter the date when the marriage ended in the format MM/DD/YYYY.
Where (Name of City and State)	Text	Provide the name of 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 was performed by someone other than a clergyman or public official and provide an explanation in the 'Remarks' section.
Spouse's date of birth (or age)	Text	Enter the date of birth or age of the deceased's spouse.
If spouse deceased, give date  of death	Date	If the deceased's spouse is also deceased, provide the date of their death.
Spouse's Social Security Number (If none or unknown, please indicate)	Text	Enter the Social Security Number of the deceased's spouse. If it is unknown or they do not have one, please indicate that.
Separation Details 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.
Surviving spouse	CheckBox	Indicate if the surviving spouse was away from home at the time of death.
Date last home	Date	Enter the date when the person last returned home before the time of death.
Reason absence began	Text	Provide the reason why the absence from home began.
Reason they were apart at time of death	Text	Provide the reason why the deceased and the surviving spouse were apart at the time of death.
If separated because of illness, enter nature of illness or disabling condition	Text	If the separation was due to illness, specify the nature of the illness or disabling condition.
SSA Contact Telephone Numbers
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	Text	Provide a telephone number to call if you have questions or need to report something regarding your claim.
TELEPHONE NUMBER	Text	Enter your telephone number for contact purposes.
SSA Office and Claim Receipt Date
SSA OFFICE	Text	Enter the name of the SSA office handling your claim.
DATE CLAIM RECEIVED	Date	Enter the date when your claim was received by the SSA.
Surviving Parent Support Question
12. Is there 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? Yes. (If "Yes," enter the name and address of the parent(s) in "Remarks".)	CheckBox	Indicate if there is a surviving parent or parents who were financially supported by the deceased at the time of their disability or death. If yes, provide the parent's name and address in the 'Remarks' section.
No	CheckBox	Indicate if there is no surviving parent or parents who were financially supported by the deceased at the time of their disability or death.
Surviving Spouse Contact (Non-Spouse Applicant)
NOTE: If there is a surviving spouse, continue with item 14. If not, skip items 14 through 17. 14. If you are not the surviving spouse, enter the surviving spouse's name and address here	Text	If you are not the surviving spouse, enter the name and address of the surviving spouse.
Surviving Spouse Disability Status
If you are the surviving spouse, and if you are under age 66, answer item 16. 16. (ay) Are you currently disabled and unable to work or was there a period during the last 14 months when you were disabled and unable to work? Yes	CheckBox	Indicate 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. Check 'Yes' if applicable.
No	CheckBox	Indicate if you are not currently disabled and have not been disabled in the last 14 months. Check 'No' if applicable.
(b) If ''Yes,'' enter the date you became disabled. (M M/D D/Y Y Y Y)	Date	If you answered 'Yes' to being disabled, enter the date you became disabled in the format MM/DD/YYYY.
Third Child Names
Full name of third child	Text	List the full name of the third child who is eligible for benefits based on the deceased's earnings record.
Full name of seventh child	Text	List the full name of the seventh child who is eligible for benefits based on the deceased's earnings record.
Unable To Work Prior To Death
6. ANSWER ITEM 6 ONLY IF THE DECEASED DIED PRIOR TO AGE 66 AND WITHIN THE PAST 4 MONTHS. (ay) Was the deceased unable to work because of illness, injuries or conditions at the time of death? Yes. (If "Yes," answer (b).)	CheckBox	Indicate whether the deceased was unable to work due to illness, injuries, or conditions at the time of death. Check 'Yes' if applicable and answer the subsequent question.
No (If "No," go on to item 7.)	CheckBox	Check 'No' if the deceased was not unable to work due to illness, injuries, or conditions at the time of death, and proceed to the next item.
(b) Enter the date the deceased became unable to work (M M/D D/Y Y Y Y)	Date	Enter the date when the deceased became unable to work in the format MM/DD/YYYY.
Witness 1 Information
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. Ay wet signature is required. Complete the form, print and sign	Text	If the application is signed by mark (X), a witness must sign here. Provide a wet signature.
Address (Number and Street, City, State, and ZIP Code)	Text	Enter the full address of the first witness, including number, street, city, state, and ZIP code.
Witness 2 Information
2. Signature of Witness. Ay wet signature is required. Complete the form, print and sign	Text	If the application is signed by mark (X), a second witness must sign here. Provide a wet signature.
Address (Number and Street, City, State, and ZIP Code)	Text	Enter the full address of the second witness, including number, street, city, state, and ZIP code.

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