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

ICR 201704-0960-003

OMB: 0960-0448

Federal Form Document

Forms and Documents
ICR Details
0960-0448 201704-0960-003
Historical Active 201404-0960-020
SSA
Application for Benefits Under a U.S. International Social Security Agreement
Revision of a currently approved collection   No
Regular
Approved without change 10/27/2017
Retrieve Notice of Action (NOA) 07/17/2017
In accordance with 5 CFR 1320, the information collection is approved for three years.
  Inventory as of this Action Requested Previously Approved
10/31/2020 36 Months From Approved 10/31/2017
17,150 0 16,200
8,575 0 8,101
0 0 0

When SSA enters into international Social Security agreements between the United States and foreign countries, applicants can file for benefits from one country, and that application can constitute an application for benefits from the other country, provided the applicants express the intent to claim benefits from the other country at the time of the initial application. SSA refers to these agreements as Totalization agreements. Under these agreements, we may base benefits on combined periods of coverage from the two agreement countries. SSA uses the information from the SSA-2490-BK to determine entitlement to Social Security benefits from the United States or from a country that has entered into a Social Security agreement with the United States. The respondents are individuals who are applying for old-age, survivors or disability benefits from the U.S. or from a Totalization agreement country.

US Code: 42 USC 433 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  82 FR 19304 04/26/2017
82 FR 31132 07/05/2017
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 17,150 16,200 0 0 950 0
Annual Time Burden (Hours) 8,575 8,101 0 0 474 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The burden change stems from the inclusion of the agreements with the United States signed with Hungary, Brazil, and Iceland.

$282,975
No
    Yes
    Yes
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.
07/17/2017


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