Information Collection

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

IC 9326 under ICR 202606-0960-008 · OMB 0960-0448.

Documents and Forms

Document Name Document Type
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
Form SSA-2960-RO U.S. / REPUBLIC OF ROMANIA AGREEMENT Application for Benefits Under a U.S. International Social Security Agreement (Paper) Form
SSA-2490-BK Application for Benefits Under a U.S. International Soci SSA-2490-BK.pdf Form
SSA-2960-RO U.S. / REPUBLIC OF ROMANIA AGREEMENT SSA-2960-RO.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-2490-BK	Application for Benefits Under a U.S. International Social Security Agreement	SSA-2490-BK.pdf		No		Paper Only
Form	SSA-2960-RO	U.S. / REPUBLIC OF ROMANIA AGREEMENT	SSA-2960-RO.pdf		Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,170	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,170	50	2,120
Annual IC Time Burden (Hours)	3,219	251	2,968
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

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