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 (Paper)	Form	Modified	Available
Justification for a Non-Substantive Change OMB-0960-0448 Uruguay and Slovenia (002).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2018-11-21	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
197844	Application for Benefits Under a U.S. International Social Security Agreement (MCS)	Other-Screens	Modified

ICR Details

OMB Control No: 0960-0448	ICR Reference No: 201811-0960-009
Status: Active	Previous ICR Reference No: 201704-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Benefits Under a U.S. International Social Security Agreement
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/07/2018
	Date Received in OIRA: 11/26/2018
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	10/31/2020	10/31/2020
Responses	17,250	0	17,150
Time Burden (Hours)	8,625	0	8,575
Cost Burden (Dollars)	0	0	0

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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. We are are doing a Change Request to include the two new agreements for Uruguay and Slovenia.

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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:
	82 FR 19304	04/26/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 31132	07/05/2017
Did the Agency receive public comments on this ICR? No

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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 (Paper)	SSA-2490-BK	Application for Benefits Under a U.S. International Social Security Agreement
Application for Benefits Under a U.S. International Social Security Agreement (MCS)

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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	17,250	17,150	0	0	100	0
Annual Time Burden (Hours)	8,625	8,575	0	0	50	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: The burden change stems from the inclusion of the agreements with the United States signed with Uruguay and Slovenia .

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Annual Cost to Federal Government: $282,975

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 11/26/2018

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