Get the up-to-date ssa 4169-2024 now

Get Form
social security administration burial Preview on Page 1

Here's how it works

01. Edit your social security administration burial online
01. Edit your ssa 4169 online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
03. Share your form with others
Send burial resource statement via email, link, or fax. You can also download it, export it or print it out.

How to edit Ssa 4169 online

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2

With DocHub, making changes to your documentation takes only some simple clicks. Follow these quick steps to edit the PDF Ssa 4169 online free of charge:

  1. Sign up and log in to your account. Log in to the editor with your credentials or click Create free account to examine the tool’s features.
  2. Add the Ssa 4169 for editing. Click the New Document option above, then drag and drop the file to the upload area, import it from the cloud, or via a link.
  3. Alter your template. Make any changes needed: insert text and pictures to your Ssa 4169, highlight information that matters, remove parts of content and replace them with new ones, and add symbols, checkmarks, and areas for filling out.
  4. Finish redacting the template. Save the updated document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is super easy to use and efficient. Give it a try now!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
The Social Security Administration (SSA) pays a small grant to eligible survivors of some beneficiaries to help with the cost of a funeral. In 2020, this amount was set by law at $255 for SSI recipients.
Form SSA-4169 is a locally reproducible form for obtaining acknowledgement of an individual's or deemor's understanding that excluded burial funds must be kept separately identifiable and that there may be a penalty for misusing the funds.
Form SSA-1695-F3 (07-2013) IMPORTANT INFORMATION. Purpose of Form. An attorney or other person who wishes to charge or collect a fee for providing services in connection with a claim before the Social Security Administration (SSA) must first obtain approval from SSA.
TYPES OF RESOURCES For Medicaid cases eligible for the liberalized policy provisions, effective 10-01-89, there is a $3000 maximum that can be excluded for burial of the individual, and up to $3000 allowed for burial of the individual's spouse (eligible or ineligible).