OMB No. 0960-0554


Go To Online Request Forms

Welcome to SSA's Online Certificate of Coverage Service.  Employers who use this service can expect to receive Certificates several weeks faster than by mail.  The online system eliminates delays due to data rekeying and provides automated error checking, resulting in fewer rejected applications.

This is one of several online processes SSA is making available as part of our efforts to provide World Class Service to the public.  Let us have your FEEDBACK on this service (but please do NOT send confidential information, such as a Social Security number, through our Feedback form).



WHO SHOULD USE THE ONLINE CERTIFICATE REQUEST FORMS

If you are a U.S. employer sending an employee to work in an agreement country for 5 years or less, you can use the online form corresponding to that agreement to request a Certificate of U.S. Coverage.  If you have an employee working in Italy, under certain conditions you can use the online form for that country even if the employee will be working there for more than 5 years.
 

CONFIDENTIALITY

SSA is taking all reasonable and appropriate measures, including encryption, to ensure that personal information you send us using the online forms is not disclosed to any third party.  However, the Internet is an open system and we cannot absolutely guarantee that the information you are sending will not be intercepted by others and decrypted.  Although this possibility is remote, it does exist.

If you are not comfortable with these risks, please see one of our articles on individual Totalization agreements to learn how to request a Certificate of Coverage by mail or fax.
 

WHERE WE WILL MAIL THE CERTIFICATE

If the employee qualifies for a Certificate, we will mail the Certificate to the U.S. address you furnish in the section of the form entitled YOUR U.S. LOCATION.  If you would like the Certificate mailed to a different U.S. address, also complete the section entitled MAILING ADDRESS at the end of the form.
 

EMPLOYEES OF FOREIGN AFFILIATES

If you are a U.S. employer, and you are sending an employee to work for a foreign affiliate of your company (rather than directly for you), please read this IMPORTANT NOTE.
 

HOW TO FILL OUT THE FORM


PERFORMER CERTIFICATE

Most countries do not try to collect social security contributions for workers who are in their territory for very short stays. Some agreement countries, however, require performers who work in their country to obtain a U.S. certificate of coverage to prove their exemption from foreign Social Security taxes, regardless of the length of time the individual will be in their country.

Because of the large number of requests involved, simplified procedures involving the issuance of abbreviated ("short-form") certificates for performers have been adopted under some of our agreements.

For purposes of the "short-form" certificate procedure, the term "performers" includes: musicians, dancers, actors, and support personnel who travel with the performers (e.g., managers and equipment handlers).

If you want to submit a performer certificate, please click Online Performer Certificate

HOW TO REACH US

If you have any questions or comments, you can reach us


PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS

The Privacy Act requires us to notify you that we are authorized to collect this information by section 233 of the Social Security Act.  While it is not mandatory for you to furnish the information to the Social Security Administration (SSA), a certificate of coverage cannot be issued unless a request has been received.  The information is needed to enable SSA to determine if current work should be covered only under the U.S. Social Security system in accordance with a Totalization agreement.  Without the certificate, current work may continue to be subject to coverage and taxation under both the U.S. and the foreign Social Security systems.

This information collection meets the clearance requirements of 44 U.S.C. ยง3507, as amended by section 2 of the Paperwork Reduction Act of 1995.  You are not required to answer these questions unless we display a valid Office of Management and Budget control number.  We estimate that it will take you about 30 minutes to read the instructions, gather the necessary facts, and answer the questions.







ONLINE REQUEST FORMS

After reading the above, if you are ready, we invite you to request a Certificate of Coverage for any of the countries listed below: Skip past Certificate of Coverage forms

Australia | Austria | Belgium | Canada | Chile | Czech Republic | Denmark | Finland | France

Germany | Greece | Ireland | Italy | Japan | Korea (South) | Luxembourg | Netherlands

Norway | Poland | Portugal | Spain | Sweden | Switzerland | United Kingdom



Future Revised Editions

SSA forms are subject to periodic revisions.  You can be assured that this SSA Internet Server Page will always have the latest edition.  Please check this Page to make certain that you have the latest edition.


Revision Date: September 1st, 2005

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