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

Forms and Documents

Document Name	Status
Form SSA-2528 Application for Benefits Under the Italy-U.S. International Social Security Agreements Form	Modified
Addendum - 0445.doc Supplementary Document	2016-04-25
Supporting Statement - 0445.doc Supporting Statement A	2016-04-25

IC Document Collections

IC ID	Document Title	Status
9322	Application for Benefits Under the Italy-U.S. International Social Security Agreements Form	Modified

ICR Details

OMB Control No: 0960-0445	ICR Reference No: 201602-0960-010
Status: Historical Active	Previous ICR Reference No: 201212-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Benefits Under the Italy-U.S. International Social Security Agreements
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: 08/17/2016
	Date Received in OIRA: 05/09/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved	08/31/2016
Responses	300	0	300
Time Burden (Hours)	100	0	100
Cost Burden (Dollars)	0	0	0

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Abstract: SSA collects information using Form SSA–2582 based on the United States-Italy agreement effective November 1, 1978. Article 19.2 of that agreement dictates that an applicant for benefits can file an application with either country. Article 4.3 of the Agreement dictates the country receiving the application will forward the agreed-upon forms and applications to the other country. As agreed upon by the United States and Italian social security agencies, individuals filing an application for U.S. benefits directly with one of the Italian social security agencies must complete Form SSA–2528. The SSA–2528 is mandatory for respondents living in Italy who wish to file an application for U.S. benefits. SSA uses the SSA–2528 to establish age, relationship, citizenship, marriage, death, military service, or to evaluate a family bible or other family record when determining eligibility for benefits. The Italian social security agencies assist applicants in completing Form SSA–2528 and then forward the application to SSA for processing. The respondents are individuals living in Italy who wish to file for U.S. Social Security benefits.

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

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 8323	02/18/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 24155	04/25/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Benefits Under the Italy-U.S. International Social Security Agreements	SSA-2528	Application for Benefits-Italy-U.S.A Agreement on Social Security

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ICR Summary 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	300	300	0	0	0	0
Annual Time Burden (Hours)	100	100	0	0	0	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:

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Annual Cost to Federal Government: $650

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

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Common Form ICR:  No

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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: 05/09/2016

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