Information Collection

Application for Benefits Under a U.S. International Social Security Agreement

IC 9326 under ICR 200806-0960-005 · OMB 0960-0448.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0448 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-2490-BK Application for Benefits Under a U.S. International Social Security Agreement Form
MCS Screens for the SSA-2490.pdf Other-database screens
SSA-2490-BK Application for Benefits Under a U.S. International Soci SSA-2490-BK.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Benefits Under a U.S. International Social Security Agreement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1925

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-2490-BK	Application for Benefits Under a U.S. International Social Security Agreement	SSA-2490-BK.pdf		No		Paper Only
Other-database screens			MCS Screens for the SSA-2490.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 42 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26,700	3,500	23,200
Annual IC Time Burden (Hours)	13,350	1,750	11,600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.