View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0051
ICR Reference No:
201608-0960-005
Status:
Historical Active
Previous ICR Reference No:
201511-0960-001
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Supplement To Claim of Person Outside the United States
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
11/08/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/07/2016
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2018
01/31/2018
01/31/2018
Responses
30,500
0
30,500
Time Burden (Hours)
4,933
0
4,933
Cost Burden (Dollars)
0
0
0
Abstract:
Claimants or beneficiaries, both United States (U.S.) citizens and aliens entitled to benefits, living outside the U.S. complete Form SSA-21 as a supplement to an application for benefits. SSA collects the information to determine eligibility for U.S. Social Security benefits for those months an alien beneficiary or claimant is outside the U.S., and to determine if tax withholding applies. In addition, SSA uses the information to: (1) allow beneficiaries or claimants to request a special payment exception in an SSA Restricted country; (2) terminate Supplemental Medical Insurance coverage for recipients who request it, because they are, or will be, out of the U.S.; and (3) allow claimants to collect a lump sum death benefit if the number holder died outside the U.S. and we do not have information to determine the whether the lump sum death is payable under the Social Security Act. The respondents are Social Security claimants, or individuals entitled to Social Security benefits, who are, will be, or have been residing outside the U.S. for three months or longer. We are making Non-Substantive changes to make the form fillable, and to make the macros easier to understand and use.
Authorizing Statute(s):
PL:
Pub.L. 98 - 21 121(c)
Name of Law: Social Security Amendments of 1983
US Code:
42 USC 402.27 (c)
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 54341
09/11/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 68951
11/19/2014
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
7
IC Title
Form No.
Form Name
SSA-21 - Non-Resident Alien (not a resident of a tax treaty country), MCS Macros Version
SSA-21 - Non-Resident Alien (not a resident of a tax treaty country), Paper Version
SSA-21
Supplement to Claim of Person Outside the United States
SSA-21 - Resident of Tax Treaty Country, Paper Version
SSA-21
Supplement to Claim of Person Outside the United States
SSA-21 - Resident of a Tax Treaty Country, MCS Macros Version
SSA-21 - U.S Resident, MCS Macros Version
SSA-21 - U.S. Citizen, Paper Version
SSA-21
Supplement to Claim of Person Outside the United States
SSA-21 - U.S. Residents, Paper Version
SSA-21
Supplement to Claim of person Outside the United States
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
30,500
30,500
0
0
0
0
Annual Time Burden (Hours)
4,933
4,933
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$107,800
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
11/07/2016
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