A signed statement from the claimant/beneficiary (or payee) showing:
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•
the individual considers themselves to be a U.S. resident;
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•
whether the individual has ever notified Department of Homeland Security (DHS) that
they had abandoned their U.S. residence, and if so, when;
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•
whether the individual has ever been notified by DHS that the individual no longer
had U.S. resident status, and if so, the date;
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•
the individual understands that as a U.S. resident their worldwide income will be
subject to U.S. income tax in the same manner as that of persons living in the U.S.;
and
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•
the individual will notify SSA promptly if their U.S. resident status is abandoned
or revoked.
NOTE: As used in this chapter, “I-551” includes all versions of the form and the I-151.
If the claimant/beneficiary does not submit the I-551 as evidence of their U.S. resident
status (as required by GN 05010.030C.2.), the statement must also show whether that I-551 was taken by DHS.
This statement may be on an application, SSA-795 or other form.
A separate statement is not necessary if the individual completes questions 10-14
on the SSA-21, since these questions are to be answered only by claimants/beneficiaries
who want to be considered U.S. residents for alien tax purposes and the explanation
of the tax, on this form, includes the taxation of worldwide income.