Certificate of Coverage Request via Letter - Employers (Poland)

Certificate of Coverage Request

OMB: 0960-0554

IC ID: 222536

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Other-Revised PA Statement
Other-Revised PA Statement
Information Collection (IC) Details

View Information Collection (IC)

Certificate of Coverage Request via Letter - Employers (Poland)
 
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
Instruction Sample Agreement Booklet (Internet Version) - Poland.pdf Yes Yes Printable Only
Other-Revised PA Statement Revised PA Statement.pdf Yes Yes Printable Only

Income Security General Retirement and Disability

 

18 0
   
Private Sector Businesses or other for-profits, Farms, Not-for-profit institutions
 
   0 %

  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 18 0 0 -39 0 57
Annual IC Time Burden (Hours) 12 0 0 -27 0 39
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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