SSA-1724-F4: Claim for Amounts due in case of a Deceased Beneficiary

Use Form SSA-1724-F4 for a deceased beneficiary who may have been due a Social Security payment and/or a Medicare Premium refund prior to or at the time of death.

SSA-1724-F4: Claim for Amounts due in case of a Deceased Beneficiary: FAQs

  • Form SSA-1724-F4 is used for a deceased beneficiary who may have been due a Social Security payment and/or a Medicare Premium refund prior to or at the time of death.

  • Send your completed Form SSA-1724-F4 to your local Social Security office.

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