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.
US Code:
42 USC 433
Name of Law: Social Security Act
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.
$156,133
No
Yes
Yes
No
No
No
No
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
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:
(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;
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.
02/24/2026
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Certificate of Coverage Request via Letter - Individuals (minus Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden, Uruguay, France, Japan, Belgium, and Poland)