Application for Benefits Under the Italy-U.S. International Social Security Agreements

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form SSA-2528-F4-IT Application for Benefits Under the Italy-U.S. International Social Security Agreements Form
SSA-2528-F4-IT Application for Benefits-Italy-U.S.A Agreement on Social Revised SSA-2528.pdf Form
SSA-2528-F4-IT.pdf Current Form SSA-2528 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Benefits Under the Italy-U.S. International Social Security Agreements	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-2528-F4-IT	Application for Benefits-Italy-U.S.A Agreement on Social Security	Revised SSA-2528.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	250	50	200
Annual IC Time Burden (Hours)	83	16	67
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current Form SSA-2528	SSA-2528-F4-IT.pdf	12/30/2009

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