Information Collection

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

IC 9322 under ICR 202205-0960-006 · OMB 0960-0445.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-2528-IT Application for Benefits Under the Italy-U.S. International Social Security Agreements	Form
Revised PA & PRA Statements.pdf	Other-Revised PA & PRA Statements
SSA-2528-IT Application for Benefits-Italy-U.S.A Agreement on Social SSA-2528-IT - Revised.pdf	Form
SSA-2528-IT - Current.pdf SSA-2528-IT - Current	IC Document

IC Title:

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-2528-IT	Application for Benefits-Italy-U.S.A Agreement on Social Security	SSA-2528-IT - Revised.pdf		No		Paper Only
Other-Revised PA & PRA Statements			Revised PA & PRA Statements.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: 462

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	462	162	300
Annual IC Time Burden (Hours)	154	54	100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-2528-IT - Current	SSA-2528-IT - Current.pdf	08/30/2022

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