Download Form SSA-1724-F4 Claim for Amounts Due in the Case of a Deceased Beneficiary
Why Did I Receive Form SSA-1724-F4?
If the SSA has some amount due to the beneficiary who is already deceased, they may pay the funds to the closest kin or legal representative of beneficiary's estate. In this case, the SSA will send you the SSA Form 1724-F4 informing about the situation and asking to complete and submit the document to determine whether you or the person you know are eligible to receive the SSA benefits due to the deceased individual.
The benefits may be paid in the following order:
- A surviving spouse that lived with the deceased at the time of death or was entitled to receive a monthly benefit on the same record;
- Children who were entitled to a monthly payment on the same record for the month of death;
- Parents who were entitled to receive a monthly benefit on the same record for the month of death;
- A surviving spouse who does not fit the abovementioned criteria;
- Children that do not meet the abovementioned requirement;
- Parents that do not qualify under item 3;
- A legal representative of the estate.
A Medicare Premium refunds are provided to the individuals or organizations who paid the beneficiary's premiums. If the beneficiary was the person who paid the premiums, the refunds are paid to a family member or a legal representative of the estate. In this case, the order of entitlement changes and the legal representative of the deceased person's estate becomes the first person eligible for Medicare Premium refunds.
Form SSA-1724-F4 Instructions
The claim is relatively easy to complete. It will take about 10 minutes to look through the instructions, to find the information, and to answer the required questions. Instructions on filling out Form SSA-1724-F4 can be found below.
How to Fill out Form SSA-1724-F4?
Fill out the form only if it shows valid Office of Management and Budget control number. Providing the requested information is totally voluntarily. However, if you fail to furnish the information you are asked about or provide incomplete data it may result in loss of your payments. Fill out the form as follows:
- Indicate the name of the deceased individual;
- Specify the SSN of the deceased individual;
- If the deceased received Social Security benefits on the record of another person, provide the name of that person;
- Specify the deceased beneficiary's date of death;
- Specify the deceased beneficiary's state of living;
- Provide your name and your relationship to the deceased;
- Enter the name of the surviving spouse. If there left none, print "None".
- Indicate the full mailing address of the surviving spouse;
- Specify the SSN of the surviving spouse;
- Specify if the surviving spouse was living in the same household as the deceased and entitled to a monthly benefit on the same earnings record. If you answered "Yes" to any of these questions, skip all the rest and sign the document at the bottom of page 2.
- Provide the number of beneficiary's children, including adopted, stepchildren, and grandchildren;
- Indicate the name, SSN, and full mailing address of each child, as well as their relation to the deceased beneficiary. If you require more space, attach a separate sheet.
- If any of the listed children has a different name from that given at birth, provide the following information on a separate sheet: the present name of a child, the name given at birth, the explanation for the difference;
- Specify the number of living parents of the deceased beneficiary, including stepparents and adopting parents. If there are no living parents, enter "None" and move to item 5. Otherwise, enter the name, SSN, and full mailing address of each parent;
- If no relatives are indicated in items 1, 2, or 4, provide the name and address of the legal representative of the deceased beneficiary's estate in item 5. Otherwise, skip this part. If you submit this form as the legal representative of the estate, attach the certified copy of your letter of appointment.
- Sign the document, provide your first name, middle initial, and last name;
- Specify the completion date;
- Indicate your contacts, including telephone number and full mailing address;
- Provide the account information, including the type of the account and the routing number.
Where to Send Form SSA-1724-F4?
If Form SSA-1724-F4 was mailed to you, place your completed document in the enclosed envelope and mail it back to the sender. If you initiate submitting of this form, take or mail it to the nearest SSA office. You can check up the address you need on the SSA website.