Certificate of Coverage Request

To obtain a certificate of coverage, SSA requires the worker or employer to write to SSA and provide personally identifiable information and details of employment. The information required to issue a certificate differs depending on the agreement negotiated with a particular country. As a result, SSA created 30 forms for each agreement corresponding to the 30 countries with which we have agreements. The forms require respondents to provide personally identifiable information about the worker; the employer; and residential locations for the worker and employer. Some of the questions include the applicant’s name, U.S. Social Security number, date of birth, country of birth, country of citizenship, country of permanent residence, date of hire, country of hire, beginning and ending date of work assignment in the foreign country, the employer, and residential location in the U.S. and abroad. The respondents are U.S. citizens and residents who wish to work in a foreign country, and their employers.

The latest form for Certificate of Coverage Request expires 2029-04-30 and is listed under ICR 202601-0960-004.

Certificate of Coverage Request via Letter - Individuals (minus Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden, Uruguay, France, Japan, Belgium, and Poland)

Federal Enterprise Architecture: Income Security - General Retirement and Disability