In accordance
with 5 CFR 1320, the information collection is approved for three
years.
Inventory as of this Action
Requested
Previously Approved
05/31/2021
36 Months From Approved
05/31/2018
18,343
0
30,500
2,132
0
4,933
0
0
0
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.
The decrease in burden hours
stems from a change in our policy to no longer require U.S.
citizens to complete this form in claims or post-entitlement
situations. In addition, based on current management data, we have
fewer respondents needing to use Form SSA-21.
$213,879
No
Yes
Yes
No
No
No
Uncollected
Faye Lipsky 410 965-8783
faye.lipsky@ssa.gov
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:
(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;
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.