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

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

⚠️ Notice: This information collection may be referencing outdated material.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 (Paper) 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 (revised).pdf Form
SSA-2490-BK (current).pdf SSA-2490-BK (current) IC Document

Information Collection (IC) Details

IC Title:	Application for Benefits Under a U.S. International Social Security Agreement (Paper)	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 (revised).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: 2,025	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,025	2,025
Annual IC Time Burden (Hours)	1,013	1,013
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-2490-BK (current)	SSA-2490-BK (current).pdf	05/09/2014

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