Information Collection

Application for Benefits Under a U.S. International Social Security Agreement (Paper)

IC 9326 under ICR 202006-0960-002 · OMB 0960-0448.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0448 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-2490-BK Application for Benefits Under a U.S. International Social Security Agreement (Paper)	Form
Form 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 (Paper)	Form
Revised PRA Statement.pdf	Other-Revised PRA Statement
Revised PRA Statement.pdf	Other-Revised PRA Statement
SSA-2490-BK Application for Benefits Under a U.S. International Soci SSA-2490-BK - Revised.pdf	Form
SSA-2490-BK Application for Benefits Under a U.S. International Soci SSA-2490-BK - Revised.pdf	Form
SSA-2490-BK - Current.pdf SSA-2490-BK - Current	IC Document
SSA-2490-BK - Current.pdf SSA-2490-BK - Current	IC Document

IC Title:

Application for Benefits Under a U.S. International Social Security Agreement (Paper)

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
Form	SSA-2490-BK				No		Paper Only
Other-Revised PRA Statement					No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,120

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,120	-20	2,140
Annual IC Time Burden (Hours)	2,968	1,898	1,070
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-2490-BK - Current		10/05/2020

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

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