Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Certificate of Coverage Request Internet- Employers (Poland) New 93 64 0 Instruction
Certificate of Coverage Request via Internet - Employers (minus Denmark, Netherlands, Norway, & Sweden) Modified 37632 25088 0 Other-Internet Application
Certificate of Coverage Request via Internet - Employers in Denmark, Netherlands, Norway, & Sweden Modified 1680 1232 0 Other-Internet Application
Certificate of Coverage Request via Internet - Individuals (minus Denmark, Netherlands, Norway, & Sweden) Modified 9407 6271 0 Other-Internet Application
Other-Revised PA
Certificate of Coverage Request via Internet - Individuals in Denmark, Netherlands, Norway, & Sweden Modified 421 309 0 Other-Internet Application
Certificate of Coverage Request via Letter - Employers (Poland) New 62 42 0 Instruction
Certificate of Coverage Request via Letter - Employers (minus Denmark, Netherlands, Norway, & Sweden) Unchanged 25087 16725 0 Instruction
Certificate of Coverage Request via Letter - Employers in Denmark, Netherlands, Norway, & Sweden Unchanged 1121 822 0 Instruction
Certificate of Coverage Request via Letter - Individuals (Poland) New 16 11 0 Instruction
Certificate of Coverage Request via Letter - Individuals (minus Denmark, Netherlands, Norway, & Sweden) Unchanged 6272 4181 0 Instruction
Certificate of Coverage Request via Letter - Individuals in Denmark, Netherlands, Norway, & Sweden Unchanged 280 205 0 Instruction
Certificate of Coverage Request via Letter -Internet- Individuals (Poland) New 23 16 0 Other-Internet Screens
Total burden requested under this ICR: 82094 54966 0  
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