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Certificate of Coverage Request via Letter - Individuals (minus Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden & Uruguay)
Certificate of Coverage Request
Revised PA Statement
Certificate of Coverage Request via Letter - Individuals (minus Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden & Uruguay)
OMB: 0960-0554
OMB.report
SSA
OMB 0960-0554
ICR 202210-0960-001
IC 9477
Certificate of Coverage Request via Letter - Individuals (minus Denmark, Iceland, Netherlands, Norway, Slovenia, Sweden & Uruguay)
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0554 can be found here:
2023-10-06 - No material or nonsubstantive change to a currently approved collection
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