OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201404-0960-020 · OMB 0960-0448 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form SSA-2490-BK Application for Benefits Under a U.S. International Social Security Agreement (Paper) Form Modified Repair queued
Form SSA-2960 SSA-2960 Form and Instruction Removed Available
Addendum 0448.doc Supplementary Document Uploaded 2014-05-09 Available
Supporting Statement 0448 (revised).doc Supporting Statement A Uploaded 2014-07-24 Available
IC Document Collections
IC IDCollectionTypeStatusForm
9326 Application for Benefits Under a U.S. International Social Security Agreement (Paper) Form Modified
201868 SSA-2960 Form and Instruction Removed
197844 Application for Benefits Under a U.S. International Social Security Agreement (MCS) Other-Screens Unchanged
ICR Details
0960-0448 201404-0960-020
Historical Active 201401-0960-007
SSA
Application for Benefits Under a U.S. International Social Security Agreement
Revision of a currently approved collection   No
Regular
Approved without change 10/20/2014
Retrieve Notice of Action (NOA) 07/25/2014
  Inventory as of this Action Requested Previously Approved
10/31/2017 36 Months From Approved 10/31/2014
16,200 0 27,200
8,101 0 8,651
0 0 0
When SSA enters into international Social Security agreements between the United States and foreign countries, applicants can file for benefits from one country, and that application can constitute an application for benefits from the other country, provided the applicants express the intent to claim benefits from the other country at the time of the initial application. SSA refers to these agreements as Totalization agreements. Under these agreements, we may base benefits on combined periods of coverage from the two agreement countries. SSA uses the information from the SSA-2490-BK to determine entitlement to Social Security benefits from the United States or from a country that has entered into a Social Security agreement with the United States. The respondents are individuals who are applying for old-age, survivors or disability benefits from the U.S. or from a Totalization agreement country. This is a non-substantive Change Request to add a new agreement to the collection. See Justification for the Non-Substantive Changes for further information.
US Code: 42 USC 433 Name of Law: Social Security Act
  
None
Not associated with rulemaking
  79 FR 26798 05/09/2014
79 FR 42863 07/23/2014
No
  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 16,200 27,200 0 -11,000 0 0
Annual Time Burden (Hours) 8,101 8,651 0 -550 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
There has been a decrease in burden hours. This change stems from the removal of Form SSA-2960.
$257,175
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]
  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.
07/25/2014