Information Collection

Certificate of Coverage Request via Letter - Employers (minus Denmark, Netherlands, Norway, & Sweden)

IC 206899 under ICR 201809-0960-001 · OMB 0960-0554.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0554 can be found here:

Documents and Forms

Document Name Document Type
Sample Agreement Booklet - Australia.pdf www.ssa.gov/international/Agreement_Pamphlets/austrlia.html Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certificate of Coverage Request via Letter - Employers (minus Denmark, Netherlands, Norway, & Sweden)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1913

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Sample Agreement Booklet - Australia.pdf	http://www.ssa.gov/international/Agreement_Pamphlets/austrlia.html	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26,031	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26,031	944	25,087
Annual IC Time Burden (Hours)	17,354	629	16,725
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.