Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Certificate of Coverage Request Internet- Employers (Poland) Unchanged 93 64 0 Instruction
Certificate of Coverage Request via Internet - Employers (minus Denmark, Netherlands, Norway, & Sweden) Modified 39072 26048 0 Other-Internet Application
Certificate of Coverage Request via Internet - Employers in Denmark, Netherlands, Norway, & Sweden Unchanged 1680 1232 0 Other-Internet Application
Certificate of Coverage Request via Internet - Individuals (minus Denmark, Netherlands, Norway, & Sweden) Modified 9761 6507 0 Other-Internet Application
Other-Revised PA
Certificate of Coverage Request via Internet - Individuals in Denmark, Netherlands, Norway, & Sweden Unchanged 421 309 0 Other-Internet Application
Certificate of Coverage Request via Letter - Employers (Poland) Unchanged 62 42 0 Instruction
Certificate of Coverage Request via Letter - Employers (minus Denmark, Netherlands, Norway, & Sweden) Modified 26031 17354 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) Unchanged 16 11 0 Instruction
Certificate of Coverage Request via Letter - Individuals (minus Denmark, Netherlands, Norway, & Sweden) Modified 6508 4339 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) Unchanged 23 16 0 Other-Internet Screens
Total burden requested under this ICR: 85068 56949 0  
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