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Federal forms, ICRs, and supporting documents

Information Collection

Certificate of Coverage Request via Letter - Individuals in Denmark, Netherlands, Norway, & Sweden, and Uruguay

IC 206897 under ICR 202309-0960-007 · OMB 0960-0554.

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

View Information Collection (IC)

Certificate of Coverage Request via Letter - Individuals in Denmark, Netherlands, Norway, & Sweden, and 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
Instruction Sample Agreement Booklet (Internet Version) - Netherlands.pdf http://www.socialsecurity.gov/international/Agreement_Pamphlets/netherld.html Yes No Printable Only
Other-Revised PA Statement Revised PA Statement.pdf Yes No Printable Only
Instruction Sample Agreement Booklet (Internet Version)-Denmark (revised).pdf Yes No Paper Only

Income Security General Retirement and Disability

 

87 0
   
Individuals or Households
 
   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 87 0 0 0 0 87
Annual IC Time Burden (Hours) 64 0 0 0 0 64
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Sample Agreement Booklet (Internet Version)- Neverlands (current) Sample Agreement Booklet (Internet Version) - Netherlands (current).pdf 09/28/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.