Information Collection

SSA-21 - Resident of Tax Treaty Country, Paper Version

IC 212847 under ICR 201707-0960-012 · OMB 0960-0051.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0051 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-21 SSA-21 - Resident of Tax Treaty Country, Paper Version Form and Instruction
Revised PA Statement.pdf Other-Revised PA Statement
SSA-21 Supplement to Claim of Person Outside the United States SSA-21 - Revised.pdf Form and Instruction
SSA-21 - Current.pdf Current SSA-21 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-21 - Resident of Tax Treaty Country, Paper Version	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 404.460 20 CFR 404.463 20 CFR 407.27(c) 20 CFR 422.505(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-21	Supplement to Claim of Person Outside the United States	SSA-21 - Revised.pdf		Yes	No	Fillable Printable
Other-Revised PA Statement			Revised PA Statement.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,751	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,751	2,081	670
Annual IC Time Burden (Hours)	413	290	123
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-21	SSA-21 - Current.pdf	10/24/2017

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