Supplement To Claim of Person Outside the United States

ICR 201608-0960-005

OMB: 0960-0051

Federal Form Document

Forms and Documents
ICR Details
0960-0051 201608-0960-005
Historical Active 201511-0960-001
SSA
Supplement To Claim of Person Outside the United States
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 11/08/2016
Retrieve Notice of Action (NOA) 11/07/2016
  Inventory as of this Action Requested Previously Approved
01/31/2018 01/31/2018 01/31/2018
30,500 0 30,500
4,933 0 4,933
0 0 0

Claimants or beneficiaries, both United States (U.S.) citizens and aliens entitled to benefits, living outside the U.S. complete Form SSA-21 as a supplement to an application for benefits. SSA collects the information to determine eligibility for U.S. Social Security benefits for those months an alien beneficiary or claimant is outside the U.S., and to determine if tax withholding applies. In addition, SSA uses the information to: (1) allow beneficiaries or claimants to request a special payment exception in an SSA Restricted country; (2) terminate Supplemental Medical Insurance coverage for recipients who request it, because they are, or will be, out of the U.S.; and (3) allow claimants to collect a lump sum death benefit if the number holder died outside the U.S. and we do not have information to determine the whether the lump sum death is payable under the Social Security Act. The respondents are Social Security claimants, or individuals entitled to Social Security benefits, who are, will be, or have been residing outside the U.S. for three months or longer. We are making Non-Substantive changes to make the form fillable, and to make the macros easier to understand and use.

PL: Pub.L. 98 - 21 121(c) Name of Law: Social Security Amendments of 1983
   US Code: 42 USC 402.27 (c) Name of Law: Social Security Act
  
None

Not associated with rulemaking

  79 FR 54341 09/11/2014
79 FR 68951 11/19/2014
No

  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 30,500 30,500 0 0 0 0
Annual Time Burden (Hours) 4,933 4,933 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$107,800
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/07/2016


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