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

Certificate of Coverage Request

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0554 can be found here:

Documents and Forms

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
Certificate of Coverage Internet Request - Denmark.pdf Certificate of Coverage IC Document
Certificate of Coverage Internet Request - Denmark.pdf Certificate of Coverage IC Document

Information Collection (IC) Details

IC Title:	Certificate of Coverage Request via Internet - Employers 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:

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

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,937	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,937	233	1,704
Annual IC Time Burden (Hours)	1,420	170	1,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.