View Information Collection Request (ICR) Package

View ICR - Agency Submission

OMB Control No: 0960-0554	ICR Reference No: 202601-0960-004
Status: Received in OIRA	Previous ICR Reference No: 202309-0960-007
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	Date Submitted to OIRA: 02/24/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	02/28/2026
Responses	20,770	32,722
Time Burden (Hours)	14,100	21,975
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	20,770	32,722	-86	-11,866
Annual Time Burden (Hours)	14,100	21,975	-259	-7,616
Annual Cost Burden (Dollars)	0	0	-3,985	3,985

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: When we last cleared this IC in 2023, the burden was 21,975 hours. However, we are currently reporting a burden of 14,100 hours. This change stems a decrease in the number of responses from 32,722 to 20,770, due to a decrease in respondents traveling and working in other countries. Although the number of responses changed, SSA did not take any action to cause this change. These figures represent current Management Information data. In addition, we have also added new Certificates of Coverage agreements with the seven countries that recently required us to include additional information (Germany, Italy, Spain, Uruguay, France, Japan, and Belgium). These new forms minorly increase the burden for the respondents from those countries. Therefore, we have increased the burden accordingly. The chart in #12 above shows the additional burden information.

Annual Cost to Federal Government: $156,133

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

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.