SSA-21 - U.S. Residents, Paper Version

Supplement To Claim of Person Outside the United States

OMB: 0960-0051

IC ID: 187515

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

SSA-21 - U.S. Residents, Paper Version
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 407.27(c) 20 CFR 404.463 20 CFR 422.505(b) 20 CFR 404.460

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.pdf Yes No Fillable Printable
Other-Revised PA Statement Revised PA Statement.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

 

510 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 510 0 0 -3,159 0 3,669
Annual IC Time Burden (Hours) 119 0 0 -798 0 917
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-21 SSA-21 - Current.pdf 10/24/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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