View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Certificate of Coverage Request via Internet - Individuals (minus Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden, Uruguay, France, Japan, Belgium, and Poland)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1913

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Internet Application http://www.ssa.gov/international/Agreement Yes Yes Fillable Fileable Signable
Other- Totalization Agreements Unified Webpage Screen Shot Yes Yes Fillable Fileable
Other-Revised Mailing Address Screen http://www.ssa.gov/international/Agreement Yes Yes Fillable Fileable Signable
Other-Revised Privacy Act Statement Yes No Printable Only

Income Security General Retirement and Disability

 

995 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 995 0 -2,087 -171 0 3,253
Annual IC Time Burden (Hours) 663 0 -1,492 -14 0 2,169
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current Mailing Address Screen 02/24/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.