Information Collection Request

Certificate of Coverage Request

ICR 202210-0960-001 · OMB 0960-0554 · Received in OIRA

⚠️ Notice: This information collection may be outdated.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

Forms and Documents

Forms and supporting documents for this ICR
Document	Type	Status	Availability
Supporting Statement - 0554 (Final).docx	Supporting Statement A	Uploaded 2022-12-14	Repair queued

IC Document Collections

Information collection document groups
IC ID	Collection	Type	Status
9477	Certificate of Coverage Request via Letter - Individuals (minus Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden & Uruguay)	Instruction	Modified
222537	Certificate of Coverage Request via Internet - Employers (Poland)	Instruction	Modified
222536	Certificate of Coverage Request via Letter - Employers (Poland)	Instruction	Modified
222535	Certificate of Coverage Request via Internet - Individuals (Poland)	Other-Internet Screens	Modified
222534	Certificate of Coverage Request via Letter - Individuals (Poland)	Instruction	Modified
206903	Certificate of Coverage Request via Internet - Employers in Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden & Uruguay)	Other-Internet Application	Modified
206902	Certificate of Coverage Request via Letter - Employers in Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden & Uruguay)	Instruction	Modified
206901	Certificate of Coverage Request via Internet - Employers (minus Denmark, Netherlands, Norway, & Sweden and Urugay)	Other-Internet Application	Modified
206899	Certificate of Coverage Request via Letter - Employers (minus Denmark,Iceland, Netherlands, Norway, Poland, Solvenia, Sweden & Uruguay)	Instruction	Modified
206898	Certificate of Coverage Request via Internet - Individuals in Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden & Uruguay	Other-Internet Application	Modified
206897	Certificate of Coverage Request via Letter - Individuals in Denmark, Netherlands, Norway, & Sweden, and Uruguay	Instruction	Modified
182116	Certificate of Coverage Request via Internet - Individuals (minus Denmark, Netherlands, Norway, & Sweden)	Other-Internet Application	Modified

ICR Details

Record metadata
Status	Received in OIRA
Agency/Subagency	SSA
OMB Control No	0960-0554
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	201905-0960-002
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31