Question	Answer
Form Name	Form Ssa 8
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	ssa 8, social security death benefits, social security form ssa 8, social security death benefits form ssa 8

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

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.

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

(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).)

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")

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?

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).)

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

	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")

Form Ssa 8 – Fill Out and Use This PDF

Form Ssa 8 PDF Details