DECLARATION OF CITIZENSHIP BY SOCIAL SECURITY BENEFICIARY OUTSIDE THE UNITED STATES

ICR 198405-0960-016

OMB: 0960-0372

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0372 198405-0960-016
Historical Active
SSA
DECLARATION OF CITIZENSHIP BY SOCIAL SECURITY BENEFICIARY OUTSIDE THE UNITED STATES
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/13/1984
Retrieve Notice of Action (NOA) 05/03/1984
  Inventory as of this Action Requested Previously Approved
05/31/1986 05/31/1986
2,400 0 0
40 0 0
0 0 0

THE INFORMATION COLLECTED BY USE OF THE FORM SSA-486-TC IS NEEDED TO DETERMINE THE CITIZENSHIP STATUS OF SOCIAL SECURITY BENEFICIARIES RESIDING IN AMERICAN SAMOA. THE AFFECTED PUBLIC IS COMPRISED OF ALL SOCIAL SECURITY BENEFICIARIES RESIDING IN AMERICAN SAMOA.

None
None


No

1
IC Title Form No. Form Name
DECLARATION OF CITIZENSHIP BY SOCIAL SECURITY BENEFICIARY OUTSIDE THE UNITED STATES SSA-486-TC

  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 2,400 0 0 2,400 0 0
Annual Time Burden (Hours) 40 0 0 40 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
05/03/1984


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