Justification for the Non-Substantive Changes to 0960-0448

Justification for Non-Substantive Changes for (SSA-2490-BK)

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

CFR Citations

OMB No. 0960-0448

Revisions to the Collection

• Change #1: Due to the new agreement between the United States and the Slovak Republic, we request to include the Slovak Republic in OMB 0960-0448.

Justification #1: Section 233 of the Social Security Act (Act) authorizes the President to enter into bilateral social security agreements between the United States and foreign countries. Under such agreements, called Totalization agreements, SSA may base retirement, survivors, disability, and derivative benefits on combined periods of coverage from the two countries. The United States signed an agreement with the Slovak Republic on December 12, 2012. 20 CFR 404.1925 of the Code of Federal Regulations provides that if an applicant files for benefits from one country, that application can constitute an application for benefits from the other country, provided the applicant express the intent to claim benefits from the other country. To assist the other country in determining the right to benefits under its laws, or in identifying coverage under its social insurance system, each country obtains certain information from the applicant and exchanges that information with the other country. Form SSA-2490-BK is the application the United States uses to obtain information needed to process claims for U.S. benefits under the existing and any future Social Security agreements. We want to include the Slovak Republic under the OMB 0960‑0448 so SSA field office personnel can collect the required information from individuals applying for benefits under the U.S. – Slovak Republic agreement.

Even though the current expiration date for 0960-0448 is 10/31/2014, we request to make this revision now rather than waiting for the full renewal of OMB’s approval for this collection. The expected entry into force date for the U.S. – Slovak Republic agreement is early 2014. If we are unable to obtain approval for these collections by the entry into force date, the United States will be in violation of the agreement.

Revisions to the Burden

We expect a marginal increase in the burden hours for this new collection, as we estimate that our respondents will initially increase by 200. The following chart shows the breakdown of the burden by modality (paper or MCS) for the SSA-2490-BK. We expect no increase for the SSA-2960:

Modality of Completion	Number of Respondents	Frequency of Response	Average Burden Per Response (minutes)	Estimated Total Annual Burden (hours)
SSA-2490-BK (MCS)	14,175	1	30	7,088
SSA-2490-BK (paper)	2,025	1	30	1,013
SSA-2960	11,000	1	3	550
Totals	27,200			8,651