Form SSA-721. Statement of Death by Funeral Director

The SSA-721 form, officially titled "Statement of Death By Funeral Director," is used by the Social Security Administration (SSA) to report the death of an individual to ensure that Social Security benefits are appropriately adjusted and disbursed. Funeral directors or authorized representatives complete this form to certify the details of the deceased person, enabling the SSA to process survivor benefits or other related claims.

Usage Case: The SSA-721 form is utilized in the following situations:

1. Reporting a Death: Funeral directors or authorized representatives use this form to report an individual's death to the SSA. This is crucial for Social Security to terminate any pre-death benefits and determine eligibility for survivor benefits.

2. Informing Survivors: Pages 2 and 3 of this form are provided to survivors of the deceased person. These pages contain important information regarding Social Security benefits and how to apply for them. It serves as an informative resource for survivors during a challenging time.

3. Providing Information: The form includes fields for recording essential details about the deceased, such as their Social Security Number (SSN), date of death, and location of death. It also allows for the submission of information about surviving family members or children.

4. Certification: Funeral directors or authorized representatives must certify the accuracy of the information provided on the form under penalty of perjury. This ensures the reliability of the information submitted to the SSA.

Form Structure:

The SSA-721 form is structured as a multi-page document, typically consisting of four pages. Here's a breakdown of the key components:

Page 1:

• Contains information about the purpose and usage of the form.
• Provides fields for recording the deceased person's name, SSN, date of death, and location of death.
• Includes sections for specifying the surviving spouse's or minor/disabled children's details.
• Contains a certification statement for the funeral director or authorized representative to sign.

Page 2:

• Provides a message from the Social Security Administration, explaining the role of the funeral director in notifying the SSA and the availability of survivor benefits.
• Offers information about the types of survivor benefits available and who may be eligible to receive them.

Page 3:

• Continues to provide information on Social Security benefits and how to apply for them.
• Lists the documents and information needed for the application process.

Page 4:

• Contains a Privacy Act Statement, explaining the collection and use of personal information by the SSA.
• Provides information about the Paperwork Reduction Act and the estimated time to complete the form.

Additional Information:

• The form emphasizes the importance of promptly notifying the SSA of a person's death to ensure the accurate termination of benefits and the initiation of survivor benefits, if applicable.
• The Privacy Act Statement informs individuals about the collection and use of their personal information for processing death benefit payments.
• The form may be submitted to the local Social Security Office.

Overall, the SSA-721 form plays a crucial role in facilitating the efficient processing of Social Security benefits for survivors while maintaining the accuracy and integrity of the SSA's records. It provides important information and instructions for those affected by a loved one's passing.