View Information Collection Request (ICR) Package

OMB Control No: 0960-0554	ICR Reference No: 202309-0960-007
Status: Active	Previous ICR Reference No: 202210-0960-001
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: 10/10/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/06/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2026	02/28/2026	02/28/2026
Responses	32,722	0	32,722
Time Burden (Hours)	21,975	0	21,975
Cost Burden (Dollars)	0	0	0

Abstract: To obtain a certificate of coverage, SSA requires the worker or employer to write to SSA and provide personally identifiable information and details of employment. The information required to issue a certificate differs depending on the agreement negotiated with a particular country. As a result, SSA created 30 forms for each agreement corresponding to the 30 countries with which we have agreements. The forms require respondents to provide personally identifiable information about the worker; the employer; and residential locations for the worker and employer. Some of the questions include the applicant’s name, U.S. Social Security number, date of birth, country of birth, country of citizenship, country of permanent residence, date of hire, country of hire, beginning and ending date of work assignment in the foreign country, the employer, and residential location in the U.S. and abroad. The respondents are U.S. citizens and residents who wish to work in a foreign country, and their employers. We are making non-substantive changes to modify our 30 Totalization informational brochures from a .PDF format to an online unified website and to modify the display hyperlink for accessing the Certificate of Coverage collection form is displayed as a button located at the top of the webpage (for easier access).

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:
	87 FR 44182	10/14/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 76532	12/14/2022
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	32,722	32,722
Annual Time Burden (Hours)	21,975	21,975
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2019, the burden was 56,556 hours. However, we are currently reporting a burden of 21,975 hours. This change stems a decrease in the number of responses from 84,473 to 36,722, due to a decrease in respondents traveling and working in other countries because of the pandemic. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.

Annual Cost to Federal Government: $291,867

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? No

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

View ICR - OIRA Conclusion