SSA-8

Application For A Lump-Sum Death Payment

Download and Print the SSA-8

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.
(This application must be filed within 2 years after the date of death of the wage earner or self-employed person.)
* This may also be considered an application for insurance benefits payable under the Railroad Retirement Act.

1. (a) PRINT name of Deceased Wage Earner or Self-Employed Person (herein referred to as the "deceased") FIRST NAME, MIDDLE INITIAL, LAST NAME

(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 Security benefits, a period of disability under Social Security, supplemental security income, or hospital or medical insurance under Medicare?
Yes - No - Unknown

(If "Yes," answer (b) and (c).)
(If "No" or "Unknown," go on to item 6.)

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