SSA-21 - Non-Resident Alien (not a resident of a tax treaty country), Paper Version

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⚠️ Notice: This information collection may be referencing outdated material.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-Resident Alien (not a resident of a tax treaty country), Paper Version Form and Instruction
SSA-21 Supplement to Claim of Person Outside the United States SSA-21 - Revised Version.pdf Form and Instruction
SSA-21 - Current Version.pdf Current SSA-21 IC Document

Information Collection (IC) Details

IC Title:	SSA-21 - Non-Resident Alien (not a resident of a tax treaty country), Paper Version	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.460 20 CFR 404.463 20 CFR 422.505(b) 42 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 and Instruction	SSA-21	Supplement to Claim of Person Outside the United States	SSA-21 - Revised Version.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: 2,557	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
Annual Number of Responses for this IC	2,557	2,557
Annual IC Time Burden (Hours)	426	426
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-21	SSA-21 - Current Version.pdf	10/07/2014

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