Certificate of Coverage Request via Internet - Individuals in Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden & Uruguay

Certificate of Coverage Request

OMB: 0960-0554

IC ID: 206898

Information Collection (IC) Details

View Information Collection (IC)

Certificate of Coverage Request via Internet - Individuals in Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden & Uruguay
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1913

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Internet Application Screen Shot Template for Denmark-Iceland-Netherlands-Norway-Sweden.pdf http://www.ssa.gov/international/totalization_agreements.html Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

122 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 122 0 0 -305 0 427
Annual IC Time Burden (Hours) 89 0 0 -224 0 313
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Certificate of Coverage Certificate of Coverage Internet Request - Denmark.pdf 09/21/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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