APPLICATION FOR BENEFITS UNDER THE ITALY-U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT

ICR 198605-0960-009

OMB: 0960-0161

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
0960-0161 198605-0960-009
Historical Active 198306-0960-007
SSA
APPLICATION FOR BENEFITS UNDER THE ITALY-U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT
No material or nonsubstantive change to a currently approved collection   No
Emergency 05/27/1986
Approved with change 05/27/1986
Retrieve Notice of Action (NOA) 05/27/1986
  Inventory as of this Action Requested Previously Approved
11/30/1986 11/30/1986 08/31/1986
4,000 0 4,000
1,667 0 1,667
0 0 0

THE INFORMATION COLLECTION BY THE USE OF THIS FORM IS NEEDED TO DETERMINE WHETHER THE APPLICANT IS ENTITLED TO OLD-AGE, SURVIVOR, DISABILITY OR DERIVATIVE BENEFITS BASED UPON COMBINED PERIODS OF COVERED EMPLOYMENT IN THE TWO COUNTRIES. AFFECTED PUBLIC INCLUDES THE WORKER, FAMILY, SPOUSE OR SURVIVORS.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR BENEFITS UNDER THE ITALY-U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT

  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 4,000 4,000 0 0 0 0
Annual Time Burden (Hours) 1,667 1,667 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
05/27/1986


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