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Federal forms, ICRs, and supporting documents

Information Collection Request

Supplement to Claim of Person Outside the United States 20 CFR 404.460-463, 20 CFR 422.505, 42 CFR 407.27

ICR 200307-0960-001 · OMB 0960-0051 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
8967 Supplement to Claim of Person Outside the United States 20 CFR 404.460-463, 20 CFR 422.505, 42 CFR 407.27 Form Migrated
ICR Details
0960-0051 200307-0960-001
Historical Active 200007-0960-001
SSA
Supplement to Claim of Person Outside the United States 20 CFR 404.460-463, 20 CFR 422.505, 42 CFR 407.27
Extension without change of a currently approved collection   No
Regular
Approved without change 08/11/2003
Retrieve Notice of Action (NOA) 07/03/2003
  Inventory as of this Action Requested Previously Approved
08/31/2006 08/31/2006 09/30/2003
35,000 0 35,000
2,917 0 2,917
0 0 0
The information collected on this form is used to determine the continuing entitlement to Social Security benefits and the proper benefit amounts of alien beneficiaries living outside the United States. It is also used to determine whether benefits are subject to withholding tax. The affected public is comprised of individuals entitled to Social Security benefits who are, will be, or have been residing outside the United States.
None
None
No
1
IC Title Form No. Form Name
Supplement to Claim of Person Outside the United States 20 CFR 404.460-463, 20 CFR 422.505, 42 CFR 407.27 SSA-21
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 35,000 35,000 0 0 0 0
Annual Time Burden (Hours) 2,917 2,917 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/03/2003