View Information Collection Request (ICR) Package
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Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0554
ICR Reference No:
201304-0960-009
Status:
Historical Active
Previous ICR Reference No:
201006-0960-004
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Certificate of Coverage Request
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
10/24/2013
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/16/2013
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
10/31/2016
36 Months From Approved
10/31/2013
Responses
70,000
0
70,000
Time Burden (Hours)
46,900
0
35,000
Cost Burden (Dollars)
0
0
0
Abstract:
The United States has agreements with 24 foreign countries to eliminate double Social Security coverage and taxation where, except for the provisions of the agreement, a worker would be subject to coverage and taxes in both countries. The country under whose system the period of work is covered issues a certificate of coverage. This certification serves as proof of exemption under the system of the other country's social security system. The information we collect assists SSA in determining a worker's coverage and in issuing a U.S. Certificate of Coverage as appropriate. Respondents are workers and employers wishing to establish exemption from foreign social security taxes.
Authorizing Statute(s):
US Code:
42 USC 433
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
78 FR 33142
06/03/2013
30-day Notice:
Federal Register Citation:
Citation Date:
78 FR 49592
08/14/2013
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
Certificate of Coverage Request via Internet - Employers (minus Denmark, Netherlands, Norway, & Sweden)
Certificate of Coverage Request via Internet - Employers in Denmark, Netherlands, Norway, & Sweden
Certificate of Coverage Request via Internet - Individuals (minus Denmark, Netherlands, Norway, & Sweden)
Certificate of Coverage Request via Internet - Individuals in Denmark, Netherlands, Norway, & Sweden
Certificate of Coverage Request via Letter - Employers (minus Denmark, Netherlands, Norway, & Sweden)
Certificate of Coverage Request via Letter - Employers in Denmark, Netherlands, Norway, & Sweden
Certificate of Coverage Request via Letter - Individuals (minus Denmark, Netherlands, Norway, & Sweden)
Certificate of Coverage Request via Letter - Individuals in Denmark, Netherlands, Norway, & Sweden
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
70,000
70,000
0
3,502
-3,502
0
Annual Time Burden (Hours)
46,900
35,000
0
2,568
9,332
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The burden increase is a result of adding three new agreements (the Czech Republic, Denmark and Poland), and the addition of the Internet-only forms. We also needed to increase the burden for the data collected from workers in Denmark, Netherlands, Norway, and Sweden due to additional questions ask as part of our agreements with those countries. See addendum for additional information.
Annual Cost to Federal Government:
$58,400
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
08/16/2013
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