SSA-21 Non-residents

Supplement To Claim of Person Outside the United States

⚠️ Notice: This information collection may be referencing outdated material.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 Non-residents Form
SSA-21 Supplement to Claim of Person Outside the United States SSA-21(current).pdf Form
SSA-21(current).pdf SSA-21 (current) IC Document

Information Collection (IC) Details

IC Title:	SSA-21 Non-residents	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 422.505(b) 20 CFR 404.460 20 CFR 404.462 20 CFR 407.27(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-21	Supplement to Claim of Person Outside the United States	SSA-21(current).pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36,874	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	36,874	19,374	17,500
Annual IC Time Burden (Hours)	3,073	1,615	1,458
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-21 (current)	SSA-21(current).pdf	10/31/2011

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