Application for U.S. Benefits Under the Canada-U.S. International Social Security Agreement

ICR 200202-0960-004

OMB: 0960-0371

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0960-0371 200202-0960-004
Historical Active 199901-0960-001
SSA
Application for U.S. Benefits Under the Canada-U.S. International Social Security Agreement
Extension without change of a currently approved collection   No
Regular
Approved without change 03/27/2002
Retrieve Notice of Action (NOA) 02/11/2002
  Inventory as of this Action Requested Previously Approved
03/31/2005 03/31/2005 03/31/2002
1,000 0 1,000
250 0 250
0 0 0

Under international agreement with the Canadian Government, the Social Security Administration uses the information collected on form sSA-1294 to determine entitlement for U.S. Social Security Benefits. The respondents are individual who live in Canada and file for U.S. Social Security benefits.

None
None


No

1
IC Title Form No. Form Name
Application for U.S. Benefits Under the Canada-U.S. International Social Security Agreement SSA-1294

  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 1,000 1,000 0 0 0 0
Annual Time Burden (Hours) 250 250 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.
02/11/2002


© 2024 OMB.report | Privacy Policy