Information Collection

SSA-21 - Resident of Tax Treaty Country, Paper Version

IC 212847 under ICR 201408-0960-011 · OMB 0960-0051.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0051 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-21 SSA-21 - Resident of Tax Treaty Country, Paper Version	Form and Instruction
SSA-21 Supplement to Claim of Person Outside the United States SSA-21 - Revised Version.pdf	Form and Instruction
SSA-21 - Current Version.pdf Current SSA-21	IC Document

IC Title:

SSA-21 - Resident of Tax Treaty Country, Paper Version

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.460 20 CFR 404.463 20 CFR 407.27(c) 20 CFR 422.505(b)

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 and Instruction	SSA-21	Supplement to Claim of Person Outside the United States	SSA-21 - Revised Version.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 670

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	670	670
Annual IC Time Burden (Hours)	123	123
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-21	SSA-21 - Current Version.pdf	10/07/2014

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