Application for Benefits Under a U.S. International Social Security Agreement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-2490-BK Application for Benefits Under a U.S. International Social Security Agreement	Form	Modified	Available
Addendum 0448.doc	Supplementary Document	Uploaded 2011-06-20	Repair queued
Supporting_Statement--0448-(Revised).doc	Supporting Statement A	Uploaded 2011-08-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9326	Application for Benefits Under a U.S. International Social Security Agreement (Paper)	Form	Modified	Application for Benefits Under a U.S. International Social Security Agreement
9326	Application for Benefits Under a U.S. International Social Security Agreement (Paper)	Other-database screens	Modified
197844	Application for Benefits Under a U.S. International Social Security Agreement (MCS)	Other-Screens	New

ICR Details

OMB Control No: 0960-0448	ICR Reference No: 201105-0960-007
Status: Historical Active	Previous ICR Reference No: 200806-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Benefits Under a U.S. International Social Security Agreement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/03/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/01/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved	11/30/2011
Responses	16,000	0	26,700
Time Burden (Hours)	8,000	0	13,350
Cost Burden (Dollars)	0	0	0

---

Abstract: When SSA enters into international Social Security agreements between the United States and foreign countries, applicants can file for benefits from one country, and that application can constitute an application for benefits from the other country, provided the applicants express the intent to claim benefits from the other country at the time of the initial application. SSA refers to these agreements as Totalization agreements. Under these agreements, we may base benefits on combined periods of coverage from the two agreement countries. SSA uses the information from the SSA-2490-BK to determine entitlement to Social Security benefits from the United States or from a country that has entered into a Social Security agreement with the United States. The respondents are individuals who are applying for old-age, survivors or disability benefits from the U.S. or from a Totalization agreement country.

---

Authorizing Statute(s): US Code: 42 USC 433 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 35067	06/15/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 53703	08/29/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Application for Benefits Under a U.S. International Social Security Agreement (MCS)
Application for Benefits Under a U.S. International Social Security Agreement (Paper)	SSA-2490-BK	Application for Benefits Under a U.S. International Social Security Agreement

---

ICR Summary of Burden

table that charts list of burden

	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	16,000	26,700	0	0	-10,700	0
Annual Time Burden (Hours)	8,000	13,350	0	0	-5,350	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There has been a decrease in burden hours. This change stems from a decrease in the number of respondents applying for totalization agreements.

---

Annual Cost to Federal Government: $201,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/01/2011

---