Justification for Non-Substantive Changes - 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 agreements the United States signed with Uruguay and Slovenia, we are adding Uruguay and Slovenia under 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 Uruguay on January 10, 2017 and with Slovenia on January 17, 2017.

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. The United States uses Form SSA-2490-BK to obtain information needed to process claims for U.S. benefits under the existing and any future Social Security agreements. We are including include Uruguay and Slovenia under OMB 0960‑0448 so SSA field office personnel can collect the required information from individuals applying for benefits under the U.S.-Uruguay and the U.S.-Slovenia agreements. The entry into force date for the U.S.-Uruguay agreement is November 1, 2018 and February 1, 2019 for Slovenia.

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 collectively by 100; 50 for Uruguay and 50 for Slovenia.

Modality of Completion	Number of Respondents	Frequency of Response	Average Burden Per Response (minutes)	Estimated Total Annual Burden (hours)
SSA-2490-BK (MCS)	15,030	1	30	7,55
SSA-2490-BK (paper)	2,140	1	30	1,070
Totals	17,250			8,625