Fillable Claim for Amounts Due in the Case of a Deceased Social Security ... - ssa
Social Security Administration
PRINT NAME OF DECEASED
Form Approved OMB No. 0960-0101
CLAIM FOR AMOUNTS DUE IN THE CASE OF A DECEASED SOCIAL SECURITY RECIPIENT
SOCIAL SECURITY NUMBER OF DECEASED ___ ___ ___ - ___ ___ - ___ ___ ___ ___ If the deceased received benefits on another person's record, print name of that worker } NAME OF THE WORKER
The deceased may have been due a Social Security payment at the time...
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