Information Collection

Application for Benefits Under the Italy-U.S. International Social Security Agreements, 20 CFR 404.1925

IC 9322 under ICR 200701-0960-019 · OMB 0960-0445.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0445 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-2528-F4-IT Application for Benefits-Itly-U.S.A Agreement on Social Security Application for Benefits Under the Italy-U.S. International Social Security Agreements, 20 CFR 404.1925	Form
SSA-2528-F4-IT Application for Benefits-Itly-U.S.A Agreement on Social SSA-2528-F4-IT.pdf	Form
PRA Statement.doc PRA Statement	IC Document

IC Title:

Application for Benefits Under the Italy-U.S. International Social Security Agreements, 20 CFR 404.1925

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1925

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-2528-F4-IT				No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PRA Statement		04/24/2007

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

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