Claim For Amounts Due In Case Of A Deceased Beneficiary

How to Obtain the Form

After you download the Adobe Acrobat Reader, come back to this page and download the PDF version of the SSA-1724:

SSA-1724 in

When To Use This Form

1. To the surviving spouse who was either living in the same household as the deceased at the time of death or who, for the month of death, was entitled to a monthly benefit on the same record as the deceased;
2. To children who, for the month of death, were entitled to a monthly benefit on the same earnings record as the deceased;
3. To parents who, for the month of death were entitled to a monthly benefit on the same earnings record as the deceased;
4. To a surviving spouse not qualified under A. above;
5. To children not qualified under B. above;
6. To parents not qualified under C. above;
7. To the legal representative of the deceased person's estate.

This form is completed to help us decide who should receive any payment due.

EVIDENCE: You should present any evidence you have which shows your relationship to the deceased. If you are claiming money as the legal representative of the estate, you should submit your appointment papers.

If you have further questions about filing for an underpayment call 1-800-772-1213, or contact your local SSA office. If you contact us, be sure to have available any letters to which you may be referring.

How to Complete the Form

SOCIAL SECURITY NUMBER OF DECEASED BENEFICIARY: The Social Security number of the beneficiary shown in number 1 with a suffix after it (i.e., HA, B2, C l, D, etc.).

NAME OF THE INSURED: If the deceased was receiving benefits on someone else's record, the name of the person on whose record the deceased was receiving social security benefits.

NAME OF CLAIMANT: Name of the person who is completing the form.

ADDRESS OF CLAIMANT: Home address of the person in number 3.

I AM CLAIMING AMOUNTS DUE FROM THE SOCIAL SECURITY ADMINISTRATION AS THE (Indicate your relationship to the deceased, i.e., widow, son, etc. or legal representative) OF (Name of decedent) WHO DIED ON THE _____ DAY OF (Month and Year), AND WHOSE FIXED PERMANENT HOME WAS IN THE STATE OF ____: Indicate your relationship to the deceased, the name of the deceased, the date of death and the state of death.

1. Complete this question if there is a surviving widow or widower. If there is none, show "none".
2. Complete this question if there are surviving children of the deceased. Include adopted children and stepchildren. Include grandchildren and stepgrandchildren if their parents are disabled or deceased or if they have been adopted by the surviving spouse of the deceased. If there are none show "none".
3. Complete this question if any of the children in 2. Above have a different name from that given at birth.
4. Complete this question if there are any surviving parents of the deceased including adoptive parents and stepparents. If there are none, show "none".
5. Complete this question only if there are no relatives listed in the other questions above.

Where To Send The Form