Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Certificate of Coverage Request via Internet - Employers (Poland) Modified 86 59 0 Instruction
Certificate of Coverage Request via Internet - Employers (minus Denmark, Netherlands, Norway, & Sweden) Modified 39096 26064 0 Other-Internet Application
Certificate of Coverage Request via Internet - Employers in Denmark, Netherlands, Norway, & Sweden Modified 1704 1250 0 Other-Internet Application
Certificate of Coverage Request via Internet - Individuals (Poland) Modified 25 17 0 Other-Internet Screens
Certificate of Coverage Request via Internet - Individuals (minus Denmark, Netherlands, Norway, & Sweden) Modified 9761 6507 0 Other-Internet Application
Certificate of Coverage Request via Internet - Individuals in Denmark, Netherlands, Norway, & Sweden Modified 427 313 0 Other-Internet Application
Certificate of Coverage Request via Letter - Employers (Poland) Modified 57 39 0 Instruction
Other-Revised PA Statement
Certificate of Coverage Request via Letter - Employers (minus Denmark, Netherlands, Norway, & Sweden) Modified 26047 17365 0 Instruction
Other-Revised PA Statement
Certificate of Coverage Request via Letter - Employers in Denmark, Netherlands, Norway, & Sweden Modified 1137 834 0 Instruction
Other-Revised PA Statement
Certificate of Coverage Request via Letter - Individuals (Poland) Modified 16 11 0 Instruction
Other-Revised PA Statement
Certificate of Coverage Request via Letter - Individuals (minus Denmark, Netherlands, Norway, & Sweden) Modified 5833 3889 0 Instruction
Other-Revised PA Statement
Certificate of Coverage Request via Letter - Individuals in Denmark, Netherlands, Norway, & Sweden Modified 284 208 0 Instruction
Other-Revised PA Statement
Total burden requested under this ICR: 84473 56556 0  
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