The Form SSA-21 serves as a supplemental claim form used by individuals residing or planning to reside outside the United States, to ensure continuous Social Security benefit eligibility and proper tax withholding. It is particularly relevant for those who are not U.S. citizens and whose residency status might affect their benefit payments and tax obligations. For individuals navigating the complexities of receiving Social Security benefits from abroad, completing the SSA-21 form accurately is essential. To ensure your Social Security benefits are processed correctly while living outside the U.S., click the button below to fill out your Form SSA-21.
The Social Security Administration's Form SSA-21, officially titled "Supplement to Claim of Person Outside the United States," is a critical document for individuals living or planning to live outside the United States who wish to claim Social Security benefits. This form is necessary for anyone who has been, is, or will be outside the U.S. for 30 consecutive days or more and seeks to claim benefits on the earnings of a worker, whether the claimant or beneficiary is a U.S. citizen or not. The form captures essential information such as the claimant's full name, country of citizenship, passport details, and the periods they have spent outside the U.S. Additionally, it addresses employment outside the U.S., and whether any benefits, such as Supplementary Medical Insurance, should be terminated due to the claimant's residence outside the country. The form also delves into tax withholding requirements for non-U.S. residents and the implications of U.S. resident status for tax purposes. Completing the SSA-21 with accurate information is crucial, as it affects the determination of eligibility and the accurate calculation of benefits, plus ensures compliance with U.S. tax laws. This documentation is then used by the Social Security Administration to make informed decisions regarding a claimant's benefit status, adhering to both the Social Security Act and the Internal Revenue Code stipulations on international beneficiaries.
Form SSA-21 (08-2022) UF
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Discontinue Prior Editions
Social Security Administration
OMB No. 0960-0051
SUPPLEMENT TO CLAIM OF PERSON OUTSIDE THE UNITED STATES (To be completed by or on behalf of person who is, was, or will be outside the U.S.)
For Social Security purposes, a person is outside the United States (U.S.) if he or she is physically outside the 50 States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa for 30 consecutive days or more.
1.
NAME OF WORKER ON WHOSE EARNINGS THIS CLAIM IS BASED
2. WORKER'S SOCIAL SECURITY NUMBER
3.Complete line (a) below for the worker (even if deceased). Complete (b) through (d) for each claimant or beneficiary who is not a U.S. citizen, and is outside the U.S., has been outside the U.S. in the past 24 months, or expects to be outside the U.S. for 30 consecutive days or more. Enter only the claimants or beneficiaries living in the same household. Complete a separate form for each household. If you need more space, use the “REMARKS” section on page 4.
FULL NAME
COUNTRY(IES) OF PRESENT
PASSPORT NO.
DATE ISSUED
CITIZENSHIP (Or at time of death)
a.
b.
c.
d.
FOR EACH WORKER LISTED ABOVE, CONTINUE TO LIST INFORMATION REQUESTED BELOW:
WORKER/PERSON LISTED ABOVE
COUNTRY
DATES OUTSIDE THE U.S.
FROM
TO
COUNTRY WHERE
OF BIRTH
Mo-Day-Yr
LIVING
WORKER LISTED ABOVE IN ROW (a.)
PERSON LISTED ABOVE IN ROW (b.)
PERSON LISTED ABOVE IN ROW (c.)
PERSON LISTED ABOVE IN ROW (d.)
NOTE: ALL PERSONS LISTED ABOVE AND IN THE "REMARKS" SECTION ON PAGE 4, OR THEIR REPRESENTATIVE PAYEES, MUST SIGN THE CERTIFICATION IN ITEM 18.
4.Complete line (a) for the worker (even if deceased). Complete (b) through (d) for each claimant or beneficiary listed in item 3 who is not a U.S. citizen. Do not include the days that residents of Canada or Mexico enter the U.S. on a daily basis to work or visit and return each day to their residence in Canada or Mexico, as dates lived in the U.S. If you need more space, use the “REMARKS” section on page 4.
TOTAL
DATES LIVED IN THE U.S.
NUMBER OF
RELATIONSHIP TO
YEARS
LIVED IN
WORKER NAMED IN ITEM 1
THE U.S.
DURING THIS PERIOD
5. Has any person listed in item 3 been employed
or self-employed outside the U.S. during any
of the past 12 months? If "yes," give name(s) and date(s) work began and submit Form
YES
NO
SSA-7163 (available at www.socialsecurity.gov). If you need more space, use the
"REMARKS" section on page 4.
NAME
Date (Mo - Yr)
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6.
Does any person listed in item 3 expect to begin employment or self-employment outside the
U.S. in the future? If "yes," give name(s) and date(s) work is expected to begin. If you need
more space, use the “REMARKS” section on page 4.
7.
Answer item 7 only if the worker named in item 1 is deceased. Did the worker die while in the
military service of the U.S. or as a result of disease or injury incurred or made worse while in
military service?
8.Supplementary Medical Insurance generally is payable only for medical services provided inside the U.S. If anyone listed in item 3 is now enrolled in Supplementary Medical Insurance under Medicare and wishes to terminate that enrollment, enter his or her name here. If you need more space, use the ”REMARKS” section on page 4.
NAME(S)
The U.S. Internal Revenue Code (IRC) requires the Social Security Administration (SSA) to withhold a 30 percent Federal income tax from 85 percent of monthly retirement, survivors and disability benefits paid to beneficiaries who are neither citizens nor residents of the United States. This results in an effective tax of 25.5 percent of the monthly benefit. SSA must withhold this tax from the benefits of all nonresident aliens except those who are residents of countries that have tax treaties with the U.S. that provide an exemption from this tax, or a lower rate of withholding. Currently these countries are Canada, Egypt, Germany, India, Ireland, Israel, Italy, Japan, Romania, Switzerland, and the United Kingdom. For details and changes regarding income tax treaties, you may check with the Internal Revenue Service.
For Federal income tax purposes, a person can be considered a U.S. resident, even if that person lives outside the United States, if he or she:
•Has not claimed a tax treaty benefit as a resident of a country other than the United States in the same year; AND
•Has been lawfully admitted to the United States for permanent residence and that residence has not been revoked or determined to have been administratively or judicially abandoned; OR
•Meets a substantial presence test as defined by the IRC. To meet this test in a given year, the person must be present in the U.S. on at least 31 days in that year, and a minimum total of 183 days counting all the days of U.S. presence in that year, one-third of the total number of days of U.S. presence in the previous year, and one-sixth of the total number of days of U.S. presence in the year before that. (The IRC defines days of U.S. presence and exclusions for applying the substantial presence test.)
If you are a U.S. resident alien for Federal income tax purposes, generally your worldwide income is subject to U.S. income tax, regardless of where you are living.
COMPLETE ITEMS 9 THROUGH 13 ABOUT ALL PERSONS LISTED IN ITEM 3 WHO ARE NOT U.S. CITIZENS AND WANT TO BE CONSIDERED U.S. RESIDENTS FOR INCOME TAX PURPOSES.
9.
Enter below the name of all persons listed in item 3 who believe they will have U.S resident status while living outside the U.S. Also show the number of each person's Permanent Resident Card (sometimes referred to as a Green Card) and the date that card was issued. If any person was not lawfully admitted for permanent residence, show "None" and explain why he or she is a U.S. resident in the "REMARKS" section on page 4.
PERMANENT RESIDENT CARD
DATE CARD WAS
(GREEN CARD) NUMBER
ISSUED
10.Enter the name(s) of any person(s) listed in item 9 who has ever notified the U.S. government, by letter or formal application, that he or she has abandoned, or wishes to abandon, his or her U.S. residence status, or has commenced to be treated as a resident of a foreign country under the provisions of a tax treaty between the U.S. and the foreign country.
Date (Mo-Yr)
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11.
Enter the name(s) of any person(s) listed in item 9 whose Permanent Resident Card has been taken away, or who has been notified by the U.S government that his or her U.S. resident status has been taken away. Enter the date of the notice or the date the Permanent Resident Card was taken away.
12.
Does each person listed in item 9 understand that, as a U.S. resident, his or her worldwide income will
be subject to U.S. income tax regardless of where he or she is living? If no, enter the name
of each individual who does not understand in the "REMARKS" section on page 4.
13.
Does each person listed in item 9 agree to notify SSA promptly if he or she abandons his or her U.S.
residence status, or if he or she commences to be treated as a resident of a foreign country under the
provisions of a tax treaty between the U.S. and the foreign country? If no, enter the name of each
individual who does not agree in the "REMARKS" section on page 4.
14.INCOME TAX TREATY BENEFITS Complete this item for any person(s) who intend(s) to claim a reduced rate of Federal income tax withholding under the provisions of an income tax treaty with the U.S. To enter additional person(s), use the "REMARKS” section on page 4.
TAX TREATY COUNTRY
DATES OF RESIDENCE
OF RESIDENCE
FROM (Mo-Yr)
TO (Mo-Yr)
15.PAYMENT ADDRESS (Where payments should be sent while you are abroad. If your payments are, or will be, sent directly to a bank or other financial institution, do not complete this item. Go to item 16.) If more than one address is required, use the "REMARKS" section below and show names for each address.
NUMBER AND STREET
CITY
POSTAL CODE
16.MAILING ADDRESS (Where your mail should be sent while you are abroad. If it is the same as the address in item 15, enter "same as 15" and go to item 17.) If more than one address is required, use the "REMARKS" section on page 4 and show names for each address.
17.RESIDENCE ADDRESS (You must complete this item if you live, or will live, at an address other than the address shown in item 15 or 16. If the address where you live, or will live, is the same as the address in item 15 or 16, enter "same as 15 (or 16 if appropriate)" and go to item 18.) If your payments are not, or will not be, sent directly to a bank or other financial institution and you receive, or will receive, them by mail at an address that is not your residence address, explain the reason in the "REMARKS" section on page 4.
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REMARKS (You may use this space for any additions and explanations. If you are giving information for a particular item on this form, enter the item number in your remark. If you need more space, attach a separate sheet.)
CERTIFICATION AND SIGNATURES
I agree to notify the Social Security Administration promptly if I (or any person for whom I receive benefits) become employed or self-employed while outside the United States, change citizenship, or go (for 30 days or more) to any country other than that indicated in item 17. I also agree to return any payments which are not due.
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I understand that anyone who knowingly gives a false or misleading statement about a material fact in this information, or causes someone else to do so, commits a crime and may be sent to prison, or may face other penalties, or both.
18.
SIGNATURE (FIRST NAME, MIDDLE INITIAL, AND
LAST NAME) OF EACH PERSON LISTED IN ITEM 3.
DATE
TELEPHONE NUMBER WHERE
REPRESENTATIVE PAYEES MUST SIGN FOR MINORS
YOU MAY BE CONTACTED
AND FOR INCAPABLE OR INCOMPETENT ADULTS.
DURING THE DAY
(Write in ink)
Witnesses are required only if this application has been signed by mark (X) in item 18.
If signed by mark (X), two witnesses who know the signer(s) must sign below, giving their full addresses.
19.(1) SIGNATURE OF WITNESS ADDRESS (NUMBER AND STREET)
(2)SIGNATURE OF WITNESS ADDRESS (NUMBER AND STREET)
POSTAL CODE COUNTRY
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Privacy Act Statement
Collection and Use of Personal Information
Sections 202(t), 203, 205, and 1836(b) of the Social Security Act and sections 871(a)(3) and 1441 of the Internal Revenue Code, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part may prevent us from making an accurate and timely decision on any claim filed or could result in the loss of benefits.
We will use the information you provide to determine eligibility for benefits. We may also share your information for the following purposes, called routine uses:
•To the IRS, Department of the Treasury, for the purpose of auditing SSA’s compliance with the safeguard provisions of the IRC of 1986, as amended; and
•To the Centers for Medicare & Medicaid Services (CMS), for the purpose of administering Medicare Part D enrollment and premium collection and Medicare Advantage Part C premium collections, as well as Medicare Part B income-related monthly adjustment amounts; and
•To contractors and other Federal agencies, as necessary, for the purpose of assisting the Social Security Administration (SSA) in the efficient administration of its programs. We will disclose information under the routine use only in situations in which SSA may enter into a contractual or similar agreement with a third party to assist in accomplishing an agency function relating to this system of records.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notices (SORN)
60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on October 31, 2019, at 84 FR 58422, 60-0090, entitled Master Beneficiary Record, as published in the FR on January 11, 2006 at 71 FR 1826; and 60-0321, entitled Medicare Database File, as published in the FR on July 25, 2006, at 71 FR 42159. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C.
§3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. Send only comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.
Filling out Form SSA-21 is an important step for individuals who are, were, or will be outside the United States and wish to claim benefits based on someone's earnings. This process requires accuracy and attention to detail to ensure that all the necessary information is provided correctly. The steps outlined below are designed to guide you through each part of the form methodically, making it a straightforward process. Remember, providing accurate and comprehensive information is crucial in facilitating the efficient processing of your claim.
Once the form is completed and all required signatures are in place, take or send it to your local Social Security office. The address and contact details for local offices can be found on the Social Security Administration's website or by contacting their hotline. This careful submission ensures your claim is processed efficiently, helping you receive the benefits you're eligible for without unnecessary delays.
What is Form SSA-21 used for?
Form SSA-21 is designed for individuals who are, were, or will be outside the United States and need to provide supplemental information to claim Social Security benefits. It's particularly necessary for those who are not U.S. citizens and have been or will be outside the U.S. for 30 consecutive days or more.
Who needs to complete Form SSA-21?
Any claimant or beneficiary who is not a U.S. citizen and who has been, is, or will be outside the U.S. for at least 30 days in a row should use this form. Each person in a household claiming benefits based on a worker’s earnings needs to provide the required information through Form SSA-21, completing separate forms for each household if needed.
What information is needed to fill out Form SSA-21?
The form requires details such as the worker's name and Social Security number, information on the claimants or beneficiaries (including country of citizenship, passport details, periods outside the U.S., and employment history outside the U.S.), and if applicable, information regarding their status as U.S. residents for tax purposes.
Where can I find Form SSA-21?
Form SSA-21 can be downloaded from the Social Security Administration’s website at www.socialsecurity.gov or obtained from a local Social Security office.
Is there a penalty for not submitting Form SSA-21?
Failing to provide the information requested on Form SSA-21 could delay the processing of your claim, affect the accuracy of any benefits you may receive, or result in the loss of benefits altogether.
How do I submit Form SSA-21?
Once completed, Form SSA-21 should be sent or brought to your local Social Security office. You can locate your nearest office via the Social Security Administration’s website or by contacting them directly through their customer service number.
Can Form SSA-21 affect my tax status?
Yes, information provided on Form SSA-21 can impact your tax withholding status if you are a nonresident alien receiving Social Security benefits. The form helps determine if benefits are subject to Federal income tax withholding at a 30% rate or if any exemptions apply due to tax treaties.
What should I do if I need more space to complete the form?
If you run out of space while filling out Form SSA-21, you can use the “REMARKS” section on page 4 for additional information. If more space is needed beyond that, attach a separate sheet to the form.
Where can I get help with completing Form SSA-21?
For assistance with filling out Form SSA-21, you can contact the Social Security Administration directly at 1-800-772-1213 for general inquiries or visit your local Social Security office for personalized help.
Filling out the Supplement to Claim of Person Outside the United States, known as Form SSA-21, is a straightforward process, but mistakes can and do happen. These errors can delay the processing of claims or impact benefit eligibility. Here are ten common mistakes to avoid.
One notable error occurs when applicants fail to report all periods spent outside the U.S. accurately. For Social Security purposes, any absence from the U.S. exceeding 30 consecutive days needs to be documented. This includes travel, living abroad, or any other reason for being outside the 50 states, District of Columbia, and U.S. territories.
An equally critical mistake is not providing complete information on employment or self-employment outside the U.S. during the past 12 months. This detail is vital for the Social Security Administration (SSA) to determine eligibility for benefits or any potential adjustments.
Frequently, applicants incorrectly assume that they do not need to list short trips back to the U.S. if living abroad. However, these dates can affect one's resident status and eligibility for benefits, making it crucial to record all time spent in the U.S., no matter how brief.
Many people also forget to update their mailing and residence addresses on the form. It's essential to provide current and accurate addresses to ensure the SSA can communicate effectively with beneficiaries outside the U.S.
Another mistake involves misunderstanding tax treaty benefits. The form asks specific questions about claiming benefits under an income tax treaty. An incorrect response could lead to inappropriate tax withholdings from benefits.
Applicants also often overlook the certification and signature requirements at the end of the form. Every person listed must sign, including representative payees for minors or adults who are incapable or incompetent. Failing to do this can result in the form being returned or not processed.
Not providing accurate information about citizenship or immigration status for each person listed can lead to problems. This includes failing to indicate if a resident card (green card) has been issued, revoked, or abandoned.
A frequent oversight is not utilizing the "Remarks" section for additional information or clarifications. This section is particularly useful when more space is needed to fully answer a question or provide necessary details.
Many people also submit the SSA-21 form without attaching required supporting documents, such as the SSA-7163 form for reporting work outside the U.S. or proof of changes in citizenship status.
Lastly, rushing through the form without carefully reading the instructions for each item often leads to errors. It's essential to take the time to thoroughly understand each question, ensuring that all responses are accurate and complete.
Avoiding these mistakes can significantly streamline the submission process, helping to ensure that benefits are received without unnecessary delays or complications.
When individuals find themselves navigating the complexities of applying for Social Security benefits while residing outside the United States, understanding the supplemental forms that may accompany Form SSA-21 is critical. These documents serve as vital components in properly communicating one’s circumstances to the Social Security Administration (SSA) for accurate and efficient processing of claims. The forms range in function from specifying work history abroad to clarifying one's status regarding Medicare. They collectively ensure that individuals maintain their eligibility and comply with the requirements of the SSA while they are outside the U.S.
Understanding each of these forms, when they are used, and how they interact with Form SSA-21 offers a strategic advantage in managing one's Social Security benefits from outside the United States. Proper completion and submission of these forms, when applicable, ensure that individuals accurately report their circumstances, thereby facilitating the receipt of appropriate benefits. This knowledge empowers beneficiaries to effectively navigate their interactions with the Social Security Administration, ensuring compliance and maximizing the benefits they are entitled to receive.
The SSA-21 form, a Supplement to Claim of Person Outside the United States, shares similarities with IRS Form 1040NR, U.S. Nonresident Alien Income Tax Return. Both forms cater to individuals outside the U.S., specifically addressing their unique tax and benefit situations. The 1040NR form is used by non-U.S. citizens to report income earned in the U.S., ensuring appropriate taxes are withheld, paralleling the SSA-21's role in managing social security benefits and tax withholdings for individuals living abroad. This alignment emphasizes the government's structured approach to handle tax and benefit obligations of residents and non-residents alike.
Another document resembling the SSA-21 form is the I-407, Record of Abandonment of Lawful Permanent Resident Status. Both documents involve notifying U.S. government agencies about significant changes in a person's residency status. While the SSA-21 includes notifying the Social Security Administration about a person's move outside the U.S., the I-407 form specifically deals with the formal process of relinquishing one's status as a legal permanent resident (Green Card holder). Despite their different functions, both forms play crucial roles in maintaining accurate status records and ensuring individuals' rights and responsibilities are up to date.
The SSA-7163, or the Questionnaire About Employment or Self-Employment Outside the United States, also shares a common purpose with the SSA-21 form. Both are designed to gather details on an individual's employment status outside the U.S. to determine eligibility for Social Security benefits. The SSA-7163 form specifically queries about recent employment history abroad, similar to how the SSA-21 requests current and future employment information for the same reason. These forms ensure that beneficiaries residing outside the U.S. meet the necessary criteria to continue receiving benefits.
Form DS-82, U.S. Passport Renewal Application for Eligible Individuals, although primarily a Department of State document, has a similar feature to the SSA-21 in terms of international mobility and residency information. The DS-82 form facilitates the renewal of U.S. passports for citizens living abroad, indirectly indicating an individual's overseas residence, much like the SSA-21 form's purpose of confirming Social Security eligibility for those outside the U.S. Both documents are instrumental in aiding U.S. citizens and non-citizens in managing their affairs while living internationally, emphasizing the importance of maintaining valid legal documentation in a global context.
Filling out the SSA-21 form is important for persons outside the United States when they claim benefits. To ensure accuracy and avoid any delays in your claim, here are key things you should and shouldn't do:
By following these guidelines, you help to ensure that your form is processed smoothly and efficiently, leading to a quicker resolution of your claim. Remember, the SSA is here to assist you, and accurate completion of the SSA-21 form is the first step in receiving the benefits you are entitled to while outside the United States.
When dealing with the SSA-21 form, several misconceptions can lead to confusion and errors in submission. Understanding these misunderstandings is crucial for accurately completing and submitting the form. Here are eight common misconceptions explained:
It's only for U.S. citizens living abroad. While the form is designed for individuals residing outside the United States, it must be completed by or on behalf of any person who is, was, or will be outside the U.S. for 30 consecutive days or more, not just U.S. citizens.
You must be outside the U.S. to complete it. You don't need to be outside the U.S. when filling out the form; it's intended for those who have been, are, or will be outside the U.S. The crucial factor is the duration of the stay outside the country.
It's only for reporting past travel. The SSA-21 form is not only for documenting past travel outside the United States. It also requires information about future plans to be outside the U.S. and current stays abroad.
All family members must be included on one form. If claimants or beneficiaries live in different households, separate forms are needed for each household. You cannot include all family members on one form unless they reside together.
Daily commuters from Canada or Mexico must report their entries into the U.S. The form specifically states not to include days on which residents of Canada or Mexico enter the U.S. for daily work or visits if they return to their home country the same day.
Employment information is not necessary. If any person listed has been employed or self-employed outside the U.S. in the past 12 months, this information must be reported, contradicting the belief that employment details are irrelevant.
Only the primary claimant needs to sign the form. Every person listed in item 3 and their representative payees, if applicable, must sign the certification in item 18, not just the primary claimant.
The form is irrelevant for tax purposes. The SSA-21 form plays a significant role in determining nonresident alien tax withholding status, contrary to the idea that it has no tax implications.
Correcting these misconceptions ensures accurate and efficient processing of the SSA-21 form, facilitating proper Social Security benefits management for those outside the United States.
Understanding and completing the SSA-21 form is crucial for individuals living outside the United States but still wish to claim benefits under a worker's Social Security earnings. Below are key takeaways to help navigate the form's requirements and ensure the submission process is smooth and accurate.
Completing the SSA-21 form is a detailed process that requires careful attention to ensure all information is accurate and reflective of the current and past situations of the claimant or beneficiary. Always consult the most current form version and instructions when preparing your claim.
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