APPLICATION FOR LUMP-SUM DEATH PAYMENT - Social Security Administration
Social Security Administration Page 1 of 4. OMB No. 0960-0013. 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. ................
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