Information Collection

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

IC 206898 under ICR 202309-0960-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Screen Shot Template for Denmark-Iceland-Netherlands-Norway-Sweden.pdf www.ssa.gov/international/totalization_agreements.html	Other-Internet Application
Screen Shot Template for Denmark-Iceland-Netherlands-Norway-Sweden.pdf www.ssa.gov/international/totalization_agreements.html	Other-Internet Application
Totalization Agreements Unified Webpage Screen Shot.docx	Other- Totalization Agreements Unifi
Totalization Agreements Unified Webpage Screen Shot.docx	Other- Totalization Agreements Unifi
Certificate of Coverage Internet Request - Denmark.pdf Certificate of Coverage	IC Document
Certificate of Coverage Internet Request - Denmark.pdf Certificate of Coverage	IC Document

IC Title:

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

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:

table that charts list of instruments
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
Other- Totalization Agreements Unified Webpage Screen Shot			Totalization Agreements Unified Webpage Screen Shot.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 122

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	122	122
Annual IC Time Burden (Hours)	89	89
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.