BASIC (11-81)

5603 NO PAYMENT DUE FOR MONTH OF DEATH

A beneficiary must be alive the entire month to be eligible for a benefit for that month. Since (a) name of deceased died (b) date of death , no benefit is payable for the month (c) month of death .

5605 UNDERPAYMENTS—GENERAL

Under the social security law, unpaid benefits due a deceased beneficiary may be paid

(A)

In the following order of priority

(B)

(Indicate appropriate priority to answer inquiry.)

1. To the surviving spouse who was either living in the same household with the deceased person at the time of his death or who was entitled to a monthly benefit on the same earnings record for the month in which the deceased person died.

2. To the child or children of the deceased person who were entitled to monthly benefits on the same earnings record for the month in which the deceased person died. (If there is more than one entitled child, in equal parts to each entitled child.)

3. To the parent or parents of the deceased person who was entitled to monthly benefits on the same earnings record for the month in which the deceased person died. (If there is more than one entitled parent, in equal parts to each entitled parent.)

4. To the person, if any, determined by the Secretary of Health and Human Services to be the surviving spouse of the deceased person.

5. To the child or children of the deceased person (if there is more than one child, in equal parts to each child).

6. To the parent or parents of the deceased person (if there is more than one parent, in equal parts to each parent).

7. To the legal representative of the estate of the deceased person.

5607A REQUESTS AMOUNT DUE DECEASED BENEFICIARY

This refers to your request for the unpaid benefits due (name of deceased beneficiary .

5607B REQUEST FOR PROOF OF RELATIONSHIP

Our records indicate that benefits of $ (a)  were due (b) name of deceased beneficiary at the time of death. Under the social security law, payment can be made to you only if (c) give priority .

If you believe that you are eligible to receive the unpaid benefits please furnish proof that you are the (d) through (g)  of the deceased.

(d)

wife

(e)

husband

(f)

child

(g)

parent

5607C REQUEST FOR SSA-1724, CLAIM FOR AMOUNTS DUE IN THE CASE OF A DECEASED BENEFICIARY

If you believe that you are eligible to receive the unpaid benefits, please complete the enclosed Form SSA-1724 (Claim for Amounts Due in the Case of a Deceased Beneficiary) and furnish the appropriate proof; e.g., marriage certificate, birth certificate, etc., to establish that you are the (h) through (l) of the deceased.

(h)

wife

(i)

husband

(j)

child

(k)

parent

(l)

legal representative of the estate

5607D UNDERPAYMENT PAID TO ANOTHER PERSON

The unpaid benefits due the deceased cannot be paid to you since you are not the highest in the order of priority.

5607E REQUIREMENTS NOT MET

Since you do not meet any of the requirements above, you are not entitled to the underpayment.