View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
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:
201809-0960-001
Status:
Historical Active
Previous ICR Reference No:
201607-0960-003
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Certificate of Coverage Request
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
10/15/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/12/2018
Terms of Clearance:
In accordance with 5 CFR 1320, the information collection is approved.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2019
12/31/2019
12/31/2019
Responses
85,068
0
82,094
Time Burden (Hours)
56,949
0
54,966
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. This is a Non-Substantive Change Request to add Brazil, Uruguay, Slovenia, and Iceland to countries with which the US has agreements.
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:
81 FR 46752
07/18/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 63837
09/16/2016
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
12
IC Title
Form No.
Form Name
Certificate of Coverage Request Internet- Employers (Poland)
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 (Poland)
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 (Poland)
Certificate of Coverage Request via Letter - Individuals (minus Denmark, Netherlands, Norway, & Sweden)
Certificate of Coverage Request via Letter - Individuals in Denmark, Netherlands, Norway, & Sweden
Certificate of Coverage Request via Letter -Internet- Individuals (Poland)
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
85,068
82,094
0
2,974
0
0
Annual Time Burden (Hours)
56,949
54,966
0
1,983
0
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:
When we last cleared this IC in 2016, the burden was 54,966 hours. However, we are currently reporting a burden of 56,949 hours. This change stems from adding new agreements with Brazil, Uruguay, Slovenia, and Iceland, increasing the number of respondents from 82,094 to 85,068. There is no change to the burden time per response.
Annual Cost to Federal Government:
$88,300
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
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:
09/12/2018
An official website of the United States government
The .gov means it's official.
The site is secure.
