Certificate of Coverage Request via Letter - Employers (minus Denmark,Iceland, Netherlands, Norway, Poland, Solvenia, Sweden & Uruguay)

Certificate of Coverage Request

OMB: 0960-0554

IC ID: 206899

Information Collection (IC) Details

View Information Collection (IC)

Certificate of Coverage Request via Letter - Employers (minus Denmark,Iceland, Netherlands, Norway, Poland, Solvenia, Sweden & Uruguay)
 
No Unchanged
 
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 - Australia.pdf http://www.ssa.gov/international/Agreement_Pamphlets/austrlia.html Yes No Printable Only
Other-Revised PA Statement Revised PA Statement.pdf Yes No Printable Only

Income Security General Retirement and Disability

 

1,135 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 1,135 0 0 0 0 1,135
Annual IC Time Burden (Hours) 757 0 0 0 0 757
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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