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This version of the form is not currently in use and is provided for reference only. Download this version of
Form SSA-721
for the current year.
Form SSA-721 Statement of Death by Funeral Director
What Is Form SSA-721?
Form SSA-721, Statement of Death by Funeral Director , is a form that should be completed by a funeral director to report the death of a person. This form was released on May 1, 2005 . A fillable Statement of Death by Funeral Director is available for download below.
Alternate Names:
- SSA Form 721;
- Funeral Director Statement of Death Form.
Information, represented in this form, is used to notify the U.S. Social Security Administration (SSA) about a person's death and allows them to determine the presence of survivors, eligible for Social Security benefits. Family members can qualify for getting different kinds of payments depending on their relation to the deceased, their age, and other parameters that can be found in the informative part of the form.
They can apply for these benefits if the deceased had sufficient work experience and paid Social Security taxes. If family members are already receiving any benefits, submitting a Funeral Director Statement of Death Form allows converting these payments to survivors' benefits.
Form SSA-721 Instructions
The Funeral Director Statement of Death Form must be filled in as follows:
- The applicant should enter the name of the deceased and their Social security number in the corresponding fields on the top.
- The funeral director must provide information about the deceased (including their name and Social Security Number) in Parts 1 through 5. Indicate the date of death, date of birth, and gender of this person.
- The applicant should enter the name of a spouse of the deceased, their address, and telephone number in Parts 6 through 7.
- The funeral director must indicate their name and address and sign the form, thus confirming the authenticity of the information provided. The applicant should enter their phone number and the date of completion as well.
An applicant has to send the form to their local Social Security office because it is not allowed to report a death online.
Download Form SSA-721 Statement of Death by Funeral Director
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