Supplement To Claim of Person Outside the United States

Forms and Documents

Document Name	Status
Form SSA-21 SSA-21 Non-residents Form	Modified
Form SSA-21 SSA-21 Residents Form	Modified
Addendum (revised).doc Supplementary Document	2011-10-31
Supporting_statement_0051 (revised).doc Supporting Statement A	2012-01-23

IC Document Collections

IC ID	Document Title	Status
8968	SSA-21 Non-residents Form	Modified
187515	SSA-21 Residents Form	Modified

ICR Details

OMB Control No: 0960-0051	ICR Reference No: 201109-0960-008
Status: Historical Active	Previous ICR Reference No: 200809-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Supplement To Claim of Person Outside the United States
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/26/2012
	Date Received in OIRA: 01/26/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	36 Months From Approved	03/31/2012
Responses	38,815	0	35,000
Time Burden (Hours)	3,558	0	5,833
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses the information it collects on Form SSA-21 to determine continuing entitlement to Social Security benefits and the proper benefit amounts of alien beneficiaries living outside the United States. SSA also uses the information to determine whether benefits are subject to withholding tax. The respondents are individuals entitled to Social Security benefits who are, will be, or have been residing outside the United States.

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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

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 65315	10/20/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 2114	01/13/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
SSA-21 Non-residents	SSA-21	Supplement to Claim of Person Outside the United States
SSA-21 Residents	SSA-21	Supplement to Claim of person Outside the United States

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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	38,815	35,000	0	0	3,815	0
Annual Time Burden (Hours)	3,558	5,833	0	0	-2,275	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: There has been an increase and decrease in burden hours. The increase stems more non-U.S. residents completing form SSA-21, the decrease stems from fewer U.S. citizens and residents completing Form SSA-21.

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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

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Common Form ICR:  No

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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: 01/26/2012

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