Information Collection

Applic. For U.s. Benefits Under Canada-u.s. Intl. Social Security Agreement & Form Ssa-1295, Understanding Between U.s. And Quebec On Ss Application For U.s. Benefits

IC 166819 under ICR 198608-0960-021 · OMB 0960-0371.

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Information Collection (IC) Details

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IC Title:	APPLIC. FOR U.S. BENEFITS UNDER CANADA-U.S. INTL. SOCIAL SECURITY AGREEMENT & FORM SSA-1295, UNDERSTANDING BETWEEN U.S. AND QUEBEC ON SS APPLICATION FOR U.S. BENEFITS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1294				No	No
Form	SSA-1295				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,400	-9,600	15,000
Annual IC Time Burden (Hours)	1,350	-2,400	3,750
Annual IC Cost Burden (Dollars)	0	0	0

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