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Federal forms, ICRs, and supporting documents

Information Collection

Certificate of Coverage Request via Letter - Employers in France and Japan

IC 279194 under ICR 202601-0960-004 · OMB 0960-0554.

Documents and Forms
Document Name
Document Type
Other-Certificate of Coverage Countr
Other-Totalization Agreements
Other-Revised Privacy Act Statement
Other-Revised Employer Mailing Addre
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Certificate of Coverage Request via Letter - Employers in France and Japan
 
No New
 
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-Certificate of Coverage Country Agreement Sample Agreement Booklet (Internet Version) - Netherlands.pdf http://www.socialsecurity.gov/international/Agreement_Pamphlets/netherld.html Yes No Printable Only
Other-Totalization Agreements Totalization Agreements Unified Webpage Screen Shot.docx http://www.ssa.gov/international/totalization_agreements.html Yes No Printable Only
Other-Revised Privacy Act Statement Updated Privacy Act Statement language for Certificate of Coverage.pdf Yes No Printable Only
Other-Revised Employer Mailing Address Screen EMP INFO Screen - Revised Version.pdf http://www.ssa.gov/international/Agreement Yes No Printable Only

Income Security General Retirement and Disability

 

12 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 12 0 12 0 0 0
Annual IC Time Burden (Hours) 8 0 8 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current Employer Mailing Address Screen EMP INFO Screen - Current Version.pdf 02/24/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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