Application for Benefits Under the Italy-U.S. International Social Security Agreements

Forms and Documents

Document Name	Status
Form SSA-2528-F4-IT Application for Benefits Under the Italy-U.S. International Social Security Agreements Form	Modified
Supporting Statement - 0445.doc Supporting Statement A	2010-04-19
Addendum - 0445.doc Supplementary Document	2010-01-22

IC Document Collections

IC ID	Document Title	Status
9322	Application for Benefits Under the Italy-U.S. International Social Security Agreements Form	Modified

ICR Details

OMB Control No: 0960-0445	ICR Reference No: 200912-0960-006
Status: Historical Active	Previous ICR Reference No: 200701-0960-019
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Benefits Under the Italy-U.S. International Social Security Agreements
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/02/2010
	Date Received in OIRA: 04/19/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2013	36 Months From Approved	07/31/2010
Responses	250	0	200
Time Burden (Hours)	83	0	67
Cost Burden (Dollars)	0	0	0

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Abstract: SSA collects information using Form SSA–2582 based on the United States-Italy agreement effective November 1, 1978. Article 19.2 of that agreement dictates that an applicant for benefits can file an application with either country. Article 4.3 of the Protocol to the Agreement dictates the country receiving the application will forward the agreed-upon forms and applications to the other country. As agreed upon by the United States and Italian Social Security agencies, individuals filing an application for U.S. benefits directly with one of the Italian Social Security agencies must complete Form SSA–2528. The SSA–2528 is mandatory for respondents living in Italy who wish to file an application for U.S. benefits. SSA uses the SSA–2528 to establish age, relationship, citizenship, marriage, death, military service, or to evaluate a family bible or other family record when determining eligibility for benefits. The Italian Social Security agencies assist applicants in completing Form SSA–2528 and then forward the application to SSA for processing. The respondents are individuals living in Italy who wish to file for U.S. Social Security benefits.

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Authorizing Statute(s): US Code: 42 USC 433 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 3778	01/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 15761	03/30/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Benefits Under the Italy-U.S. International Social Security Agreements	SSA-2528-F4-IT	Application for Benefits-Italy-U.S.A Agreement on Social Security

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ICR Summary of Burden

	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	250	200	0	0	50	0
Annual Time Burden (Hours)	83	67	0	0	16	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this information collection tool in 2007, the burden was 67 hours. However, we are currently reporting a burden of 83 hours. This change stems from an increase in the number of respondents who are completing this form.

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Annual Cost to Federal Government: $150

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/19/2010

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