Certificate of Coverage Request

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Supporting Statement 0960-0554.doc	Supporting Statement A	Uploaded 2010-08-13	Available
Addendum to Supporting Statement 0960-0554.doc	Supplementary Document	Uploaded 2010-08-12	Available
COC INFORMATION ELEMENTS COLLECTED 2010.doc	Supplementary Document	Uploaded 2010-07-15	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9477	Certificate of Coverage Request --Individuals 20 CFR 404.1913	Instruction	Modified
182116	Certificate of Coverage Request--Private Sector 20 CFR 404.1913	Instruction	Modified

ICR Details

OMB Control No: 0960-0554	ICR Reference No: 201006-0960-004
Status: Historical Active	Previous ICR Reference No: 200709-0960-013
Agency/Subagency: SSA	Agency Tracking No:
Title: Certificate of Coverage Request
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: 10/04/2010
	Date Received in OIRA: 08/27/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2013	36 Months From Approved	12/31/2010
Responses	70,000	0	50,000
Time Burden (Hours)	35,000	0	25,000
Cost Burden (Dollars)	0	0	0

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Abstract: The United States has agreements with 24 foreign countries to eliminate double Social Security coverage and taxation where, except for the provisions of the agreement, a worker would be subject to coverage and taxes in both countries. The country under whose system the period of work is covered issues a certificate of coverage. This certification serves as proof of exemption under the system of the other country's social security system. The information we collect assists SSA in determining a worker's coverage and in issuing a U.S. Certificate of Coverage as appropriate. Respondents are workers and employers wishing to establish exemption from foreign social security taxes.

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Authorizing Statute(s): US Code: 42 USC 433 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:
	75 FR 32231	06/07/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 49013	08/12/2010
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Certificate of Coverage Request --Individuals 20 CFR 404.1913
Certificate of Coverage Request--Private Sector 20 CFR 404.1913

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ICR Summary of Burden

table that charts list 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	70,000	50,000	0	20,000	0	0
Annual Time Burden (Hours)	35,000	25,000	0	10,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden is due to the addition of three new agreements (Czech Republic, Denmark, and Poland)that went into effect during this approval period, effectively increasing the total number of respondents and annual burden.

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Annual Cost to Federal Government: $58,400

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]? Uncollected

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: 08/27/2010

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