Information Collection

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

IC 9322 under ICR 201904-0960-004 · OMB 0960-0445.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0445 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-2528 - Revised Privacy Act Statement.pdf	Other-Revised Privacy Act Statement
SSA-2528-IT Application for Benefits-Italy-U.S.A Agreement on Social SSA-2528 IT - Revised Version.pdf	Form
SSA-2528 IT - Current Version.pdf Current SSA-2528-IT	IC Document

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1925

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
Other-Revised Privacy Act Statement			SSA-2528 - Revised Privacy Act Statement.pdf		No		Paper Only
Form	SSA-2528-IT	Application for Benefits-Italy-U.S.A Agreement on Social Security	SSA-2528 IT - Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-2528-IT	SSA-2528 IT - Current Version.pdf	08/02/2019

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