Information Collection

Supplement to Claim of Person Outside the United States

IC 33957 under ICR 202001-3220-001 · OMB 3220-0155.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0155 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-45 Supplement to Claim of Person Outside the United States	Form and Instruction
G-45 Supplement to Claim of Person Outside the United States Form G-45 (05-13).pdf	Form and Instruction
G-45 Supplement to Claim of Person Outside the United States Form G-45 (xx-xx) - Proposed.pdf	Form and Instruction
Form SSA-21 (05-2018).pdf SSA-21	IC Document

IC Title:

Supplement to Claim of Person Outside the United States

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
Form and Instruction	G-45	Supplement to Claim of Person Outside the United States - PROPOSED	Form G-45 (xx-xx) - Proposed.pdf		No		Paper Only
Form and Instruction	G-45	Supplement to Claim of Person Outside the United States - CURRENT	Form G-45 (05-13).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System

FR Citation: 79 FR 58874

Number of Respondents: 100

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	100	100
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-21	Form SSA-21 (05-2018).pdf	02/14/2020

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