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Citizenship;

© Country of permanent residence;

e U.S. and/or Norwegian Social Security number;

© Name, relationship and date of birth of family members accompanying you;
© Address in Norway, if known;

© Nature of self-employment activity;

* Dates the activity was or will be performed; and

* Name and address of your trade or business in both countries.

Effective Date Of Coverage Exemption

The certificate of coverage you receive from one country will show the effective date of your exemption from paying Social Security
taxes in the other country. Generally, this will be the date you began working in the other country.

Certificates of coverage issued by Norway should be retained by the employer in the United States in case of an audit by the IRS.
No copies should be sent to IRS unless specifically requested by IRS. However, a self-employed person must attach a photocopy of
the certificate to his or her tax return each year as proof of the U.S. exemption.

Copies of certificates of coverage issued by the United States will be provided for both the employee and the employer. It will be
their responsibility to present the certificate to the Norwegian authorities when requested to do so. To avoid any difficulties, your
employer (or you, if you are self-employed) should request a certificate as early as possible, preferably before your work in the
other country begins.

If you or your employer request a certificate of coverage, you should read the Privacy Act and Paperwork Reduction Act Statements
below.

Authority to collect information for a certificate of coverage
Privacy Act

|The Privacy Act requires us to notify you that we are authorized to collect this information by section 233 of the Social Security Act.

hile 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 work should be
covered only under the U.S. Social Security system in accordance with an international agreement. Without the certificate, work
Imay be subject to taxation under both the U.S. and the foreign Social Security systems.

Paperwork Reduction Act Notice

[This information collection meets the clearance requirements of 44 U.S.C. section 3507, 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

(OMB) control number. We estimate that it will take you about 30 minutes to read the instructions, gather the necessary facts, and
rite down the information to request a certificate of coverage.

Monthly benefits

The following table shows the various types of Social Security benefits payable under the U.S. and Norwegian Social Security
systems and briefly describes the eligibility requirements that normally apply for each type of benefit. If you do not meet the
normal requirements for these benefits, the agreement may help you to qualify (see "How benefits can be paid” section below).

We should point out that Norway pays benefits through a two-tier program: the first tier pays a basic pension based on residence;
and the second tier pays an earnings-related supplementary pension. If you have not lived or worked in Norway long enough to

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States (Publication No. 05-10137).

Appeals

If you disagree with the decision made on your claim for benefits under the agreement, contact any U.S. or Norwegian Social
Security office. The people there can tell you what you need to do to appeal the decision.

The Norwegian Social Security authorities will review your appeal if it affects your rights under the Norwegian system, while U.S.
Social Security authorities will review your appeal if it affects your rights under the U.S. system. Since each country’s decisions are
made independently of the other, a decision by one country on a particular issue may not always conform with the decision made
by the other country on the same issue.

For more information
To file a claim for U.S. or Norwegian benefits under the agreement, follow the instructions in "Claims for benefits" section.

To find out more about U.S. Social Security benefits or for information about a claim for benefits, contact any U.S. Social Security
office. If you live outside the United States, write to:

Social Security Administration
O1O0—Totalization

P.O. Box 17769

Baltimore, Maryland 21235-7769
USA

For more information about Norway's Social Security programs, visit any Social Security office in Norway. If you don't live in
Norway, write to:

National Insurance Administration
International Affairs Division
N-0241 Olso

NORWAY

If you do not wish to file a claim for benefits, but would like more information about the agreement, write to:

Social Security Administration
Office of International Programs
P.O. Box 17741

Baltimore, Maryland 21235-7741
USA

For additional information visit our website: www.socialsecurity.gov/international.

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lbeen married to worker for at least 10
ears.

Totalization Agreement with Norway

(Children-If unmarried, up to age 18 (age
19 if in an elementary or secondary school
full time) or any age if disabled before age’
22.

(Children-Supplement paid to worker if
child is under age 18.

Survivors benefits

United States

Norway

Widow or widower-Full benefit at full
retirement age or at any age if caring for
the deceased's entitled child under age 16
(or disabled before age 22). Reduced
benefit as early as age 60 (or age 50 if
\disabled) if not caring for child. Benefits
Imay be continued if remarriage occurs
after age 60 (or age 50 if disabled).

Widow or widower-

\Under age 67 and marriage lasted at least
ive years or a child was born of the

jarriage or surviving spouse is caring for
deceased's children.

Deceased worker or surviving spouse

just have had at least three years of
coverage and the ability to work for at
least three years immediately prior to
death or been receiving a pension for at
least three years prior to death.

Benefit not payable outside Norway
unless the deceased was also entitled to
upplementary pension or the deceased
or the widow or widower resided in
Norway for 20 years.

[Divorced widow or widower-Same as
idow or widower if marriage lasted at
least 10 years.

Divorced widow-Under age 67 and not
remarried and death occurred within five
ears of the divorce. Marriage lasted at
least 25 years or 15 years if there were
hildren of the marriage.

Benefit not payable outside Norway
inless also entitled to supplementary
ension or the deceased or the divorced
idow or widower resided in Norway for

20 years.

(Children-Same as for children of retired
r disabled worker.

\Children-Under age 18 (or age 20 if a
student or both parents deceased).

Lump-sum death benefit-A one-time
payment not to exceed $255 payable on
he death of an insured worker.

Lump-sum death benefit-Funeral grant
ayable.

How Benefits Can Be Paid

If you have Social Security credits in both the United States and Norway, you may be eligible for benefits from one or both
countries. If you meet all the basic requirements under one country’s system, you will get a regular benefit from that country. If you
do not meet the basic requirements, the agreement may help you qualify for a benefit as explained below.

© Benefits from the U.S.—If you do not have enough work credits under the U.S. system to qualify for regular benefits, you

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qualify for benefits under one or both of these programs, U.S. Social Security credits may help you become entitled.

This table is only a general guide. You can get more specific information about U.S. benefits here on our web site or at any U.S.
Social Security office or by calling our toll-free number at 1-800-772-1213. You can get more detailed information about the
Norwegian system by writing to the Norwegian address in "Certificates for employees" section or by visiting the Norwegian Social
Security system web site at http://www.nav.no.

Under U.S. Social Security, you may earn up to four credits each year depending on the amount of your covered earnings. The
amount needed to earn a work credit goes up slightly each year. For more information, see How You Earn Credits (SSA Publication
No. 05-10072).

Under the Norwegian system, credits are measured in years known as "pension point years." To simplify the information in the
table, U.S. requirements are also shown in years of credits.

Monthly Benefits And Eligibility Requirements

Retirement or old-age benefits
United States Norway
Worker-Full benefit at full retirement age, Worker-
jor reduced benefit as early as age 62.
Required work credits range from one and
jone-half to 10 years (10 years if 62 in 1991) esidence in Norway.
jor later).

Basic: Age 67 with at least three years of

Supplementary: Age 67 with at least
hree years of coverage after 1966.

Disability benefits
United States Norway
Worker-Under full retirement age can get Worker-
benefit if unable to do any substantial
gainful work for at least a year. One and
jone-half to 10 years credit
Ineeded, depending on age at date of
jonset. Some recent work credits also

Basic: Age 18 to 67 with three years of
credits (i.e, residence) immediately
receding onset of disability. Must have at,
least 50 percent loss of work capacity.
needed unless worker is blind. Benefit not payable outside Norway
inless also entitled to supplementary
ension or residence in Norway for

20 years after age 18.

Supplementary: Same as basic except
hree years of earnings above a base
amount after 1966 is needed and the
benefit is payable outside of Norway.

Family benefits to dependents of retired or disabled persons

United States Norway

Spouse-Full benefit at full retirement age Spouse-Supplement paid to worker if

or at any age if caring for the worker's upporting a spouse who does not receive}
entitled child under age 16 (or disabled —_ own pension.

before age 22). Reduced benefit as early
las age 62 if not caring for a child.

Divorced spouse-Full benefit at full Divorced spouse-Payable under certain
retirement age. Reduced benefit as early conditions.
jas age 62. Must be unmarried and have

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What you need to know about Medicare

Medicare is the U.S. national health insurance system for people age 65 or older or who are disabled. Medicare has two parts:
hospital insurance (also called "Part A" Medicare) and medical insurance (called "Part B" Medicare). You are eligible for free hospital
insurance at age 65 if you have worked long enough under U.S. Social Security to qualify for a retirement benefit. People born in
1929 or later need 40 credits (about 10 years of covered work) to qualify for retirement benefits.

Although the agreement between the United States and Norway allows the Social Security Administration to count your Norwegian
credits to help you qualify for U.S. retirement, disability or survivor benefits, the agreement does not cover Medicare benefits. As a
result, we cannot count your credits in Norway to establish entitlement to free Medicare hospital insurance.

For more information about Medicare, call our toll-free number, 1-800-772-1213, and ask for the publication, Medicare
(Publication No. 05-10043) or visit Medicare's website at www.medicare.gov.

Claims for benefits

If you live in the United States and wish to apply for U.S. or Norwegian benefits:

® Visit or write any U.S. Social Security office; or
© Phone our toll-free number, 1-800-772-1213, 7 a.m. to 7 p.m. any business day. People who are deaf or hard of hearing may
call our toll-free TTY number, 1-800-325-0778.

You can apply for Norwegian benefits at any U.S. Social Security office by completing an application form SSA-2490.
If you live in Norway and wish to apply for U.S. or Norwegian benefits, contact:

© The Federal Benefits Unit at the U.S. Embassy in Oslo (phone 2-2448-550) to file for U.S. benefits; or
« Any Norwegian Social Security office to file for Norwegian benefits.

You can apply with one country and ask to have your application considered as a claim for benefits from the other country.
Information from your application will then be sent to the other country. Each country will process the claim under its own laws—
counting credits from the other country when appropriate—and notify you of its decision.

If you have not applied for benefits before, you may need to provide certain information and documents when you apply. These
include the worker's U.S. and Norwegian Social Security numbers, proof of age for all claimants, evidence of the worker's U.S.
earnings in the past 24 months and information about the worker's coverage under the Norwegian system. You may wish to call
the Social Security office before you go there to see if any other information is needed.

Payment Of Benefits

Each country pays its own benefit. U.S. payments are made by the U.S. Department of Treasury each month and cover benefits for
the preceding month. Payments under the Norwegian system are made monthly, in advance, through the Norwegian Postal
System.

Absence From U.S. Territory

Normally, persons who are not U.S. citizens may receive U.S. Social Security benefits while outside the U.S. only if they meet certain
requirements. Under the agreement, however, you may receive benefits as long as you reside in Norway regardless of your
nationality. If you are not a U.S. or Norwegian citizen and live in another country, you may not be able to receive benefits. The
restrictions on U.S. benefits are explained in the publication, Social Security—Your Payments While You Are Outside The United

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Social Security

Official Social Security Website

International Programs

Totalization Agreement with Norway
SSA Publication No. 05-10195, January 2004, ICN 480205 [OMB Approval Number: 0960-0554 Expires 12/31/2016]

Contents

Introduction

Coverage and Social Security taxes

Certificate of coverage

Monthly benefits

A Norwegian "supplementary" pension may affect your U.S. benefit
What you need to know about Medicare

Claims for benefits

For more information

Introduction

An agreement effective July 1, 1984, between the United States and Norway improves Social Security protection for people who
work or have worked in both countries. It helps many people who, without the agreement, would not be eligible for monthly
retirement, disability or survivors benefits under the Social Security system of one or both countries. It also helps people who would
otherwise have to pay Social Security taxes to both countries on the same earnings.

The agreement covers Social Security taxes (including the U.S. Medicare portion) and Social Security retirement, disability and
survivors insurance benefits. It does not cover benefits under the U.S. Medicare program or the Supplemental Security Income
program.

This document covers highlights of the agreement and explains how it may help you while you work and when you apply for
benefits.

The Agreement May Help You, Your Family And Your Employer

While you work—If your work is covered by both the U.S. and Norwegian Social Security systems, you (and your employer, if
you are employed) would normally have to pay Social Security taxes to both countries for the same work. However, the
agreement eliminates this double coverage so you pay taxes to only one system (see the section on "Coverage and Social
Security taxes").

«© When you apply for benefits—You may have some Social Security credits in both the U.S. and Norway but not have enough
to be eligible for benefits in one country or the other. The agreement makes it easier to qualify for benefits by letting you add
together your Social Security credits in both countries. For more details, see the section on "Monthly benefits".

Coverage and Social Security taxes

Before the agreement, employees, employers and self-employed people could, under certain circumstances, be required to pay
Social Security taxes to both the United States and Norway for the same work.

Under the agreement, if you work as an employee in the United States, you normally will be covered by the United States, and you
and your employer will pay Social Security taxes only to the United States. If you work as an employee in Norway, you normally will
be covered by Norway, and you and your employer pay Social Security taxes only to Norway.

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may be able to qualify for a partial benefit from the United States based on both U.S. and Norwegian credits. However, to be
eligible to have your Norwegian credits counted, you must have earned at least six credits (generally one and one-half years
of work) under the U.S. system. If you already have enough credits under the U.S. system to qualify for a benefit, the United
States cannot count your Norwegian credits.

© Benefits from Norway—Norway provides retirement, disability and survivors benefits through two separate programs.

1. A "basic" pension program pays flat-rate benefits to Norwegian residents in proportion to the number of years they
have resided in Norway. The benefit amount is unrelated to past earnings. In determining eligibility for a basic pension,
any year with earnings credited under the supplementary system is automatically credited as a year of residence, even if
a person did not actually reside in Norway.

If you have resided in Norway for at least one year, but not long enough to meet the applicable coverage requirement
for a basic pension, your U.S. and Norwegian coverage can be combined to meet the three-year minimum coverage
requirement for retirement benefits, or to meet the recent-coverage requirements that apply to disability and survivors
benefits. In addition, Norway will pay basic disability and survivors benefits, which were formerly payable only to
residents of Norway, if you reside in the United States.

2. A "supplementary" pension program for workers pays benefits based on how long you worked in Norway and the
amount you earned.
If you have at least one year of coverage under Norway's supplementary pension system, but not enough to meet the
three-year minimum requirement for a retirement, survivors or disability pension, your U.S. credits can be added to your
supplementary credits to meet this requirement. In addition, U.S. credits can be used to meet the recent-coverage
requirement for the surviving spouse's pension.

How Credits Get Counted

You do not have to do anything to have your credits in one country counted by the other country. If we need to count your credits
under the Norwegian system to help you qualify for a U.S. benefit, we will get a copy of your Norwegian record directly from
Norway when you apply for benefits. If Norway needs to count your U.S. credits to help you qualify for a Norwegian benefit, they
will get a copy of your U.S. record directly from the Social Security Administration when you apply for the Norwegian benefit.

Although each country may count your credits in the other country, your credits are not actually transferred from one country to
the other. They remain on your record in the country where you earned them and also can be used to qualify for benefits there.

Computation Of U.S. Benefit Under The Agreement

When a USS. benefit becomes payable as a result of counting both U.S. and Norwegian Social Security credits, an initial benefit is
determined based on your U.S. earnings as if your entire career had been completed under the U.S. system. This initial benefit is
then reduced to reflect the fact that Norwegian credits helped to make the benefit payable. The amount of the reduction will
depend on the number of U.S. credits: the more U.S. credits, the smaller the reduction; and the fewer U.S. credits, the larger the
reduction.

A Norwegian "supplementary" pension may affect your U.S. benefit

If you qualify for Social Security benefits from the United States based only on U.S. credits and a “supplementary” pension from
Norway, the amount of your U.S. benefit may be reduced. This is a result of a provision in U.S. law which can affect the way your
benefit is figured if you also receive a pension based on work that was not covered by U.S. Social Security. Receipt of a Norwegian
“basic” pension, which is based on residence in Norway, will not affect the way your U.S. benefit is figured. For more information,
call our toll-free number, 1-800-772-1213, and get the publication, Windfall Elimination Provision (Publication No. 05-10045). If
you are outside the United States, you may write to us at the address in "For more information” section.

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Baltimore, MD 21235-7741
USA

The request may be sent by FAX, if preferred, to (410) 966-1861. Please note this FAX number should only be used for requesting
certificates of coverage.

No special form is required to request a certificate, but, the request must be in writing and provide the following information:

© Full name of worker;

© Date and place of birth;

© Citizenship;

© Country of worker's permanent residence;

© Worker's address in Norway (if known);

e U.S. and/or Norwegian Social Security number;

* Name, relationship and date of birth of family members accompanying the worker;
© Date of hire;

© Country of hire;

© Name and address of the employer in the U.S. and Norway; and
© Date of transfer and anticipated date of return.

In addition, your employer must indicate if you remain an employee of the U.S. company while working in Norway or if you become
an employee of the U.S. company’s affiliate in Norway. If you become an employee of an affiliate, your employer must indicate if
the U.S. company has an agreement with the Internal Revenue Service under section 3121(I) of the Internal Revenue Code to pay
U.S. Social Security taxes for U.S. citizens and residents employed by the affiliate and, if yes, the effective date of the agreement.

Your employer can also request a certificate of U.S. coverage for you over the Internet using a special online request form available
at www.socialsecurity.gov/coc. Only an employer can use the online form to request a certificate of coverage. A self-employed
person must submit a request by mail or fax.

To establish your exemption from coverage under the U.S. Social Security system, your employer in Norway must request a
certificate of coverage (form N/USA 2) from Norway at this address:

National Insurance Administration
International Affairs Division
N-0241 Olso

NORWAY

The same information required for a certificate of coverage from the United States is needed to get a certificate from Norway
except that you must show your Norwegian social insurance number rather than your U.S. Social Security number.

Certificates For Self-Employed People

If you are self-employed and would normally have to pay Social Security taxes to both the U.S. and Norwegian systems, you can
establish your exemption from one of the taxes by writing to:

© Ifyou reside in the United States, the U.S. Social Security Administration at the address in "Certificates for employees" section;
or
© If you reside in Norway, the National Insurance Administration at the address in "Certificates for employees" section.

Be sure to provide the following information in your letter:

e Full name;
© Date and place of birth;

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© Sent you to work in the U.S. for more than

five years
U.S.
© Hired you in the U.S.
For a non-Norwegian employer U.S.
or the Norwegian government and you are a:
Norway
© Norwegian national
U.S.
e US. citizen
You are self-employed and you:
U.S.
Reside in the U.S.
Norway

© Reside in Norway

if this table does not seem to describe your situation and you are:

rite to the U.S. address in
"Certificates for employees" section
below for further information.

© Working in the U.S.

rite to the Norway address in "For
more information" section below for|
further information.

© Working in Norway

Note

As the table indicates, a U.S. worker employed in Norway can be covered by U.S. Social Security only if he or she works for a U.S.
employer. A U.S. employer includes a corporation organized under the laws of the United States or any state, a partnership if at
least two-thirds of the partners are U.S. residents, an individual who is a resident of the U.S. or a trust if all the trustees are U.S.
residents. The term also includes a foreign affiliate of a U.S. employer if the U.S. employer has entered into an agreement with the
Internal Revenue Service under section 3121(l) of the Internal Revenue Code to pay Social Security taxes for U.S. citizens and
residents employed by the affiliate.

Certificate of coverage

A certificate of coverage issued by one country serves as proof of exemption from Social Security taxes on the same earnings in the
other country.

Certificates for employees
To establish an exemption from compulsory coverage and taxes under the Norwegian system, your employer must request a
certificate of coverage (form USA/N 101) from the U.S. at this address:

Social Security Administration
Office of International Programs
P.O. Box 17741

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On the other hand, if your employer sends you from one country to work for that employer or an affiliate in the other country for
five years or less, you will continue to be covered by your home country and you will be exempt from coverage in the other
country. For example, if a U.S. company sends an employee to work for that employer or an affiliate in Norway for no more than
five years, the employer and the employee will continue to pay only U.S. Social Security taxes and will not have to pay in Norway.

If you are self-employed and reside in the United States or Norway, you generally will be covered and taxed only by the country
where you reside.

Special coverage rules apply to persons working on the Norwegian Continental Shelf (oil exploration activities, for example). Write
to either address in "Certificates for employees" section and for specific information.

NOTE: In addition to retirement, survivors and disability benefits, Norwegian Social Security taxes cover several other programs
including unemployment and work accident insurance and certain benefits for unwed mothers. As a result, workers exempted from
Norwegian Social Security coverage by the agreement pay no Social Security taxes for these programs and generally cannot receive
benefits from them. If the agreement exempts you from Norwegian coverage, you and your employer may wish to arrange for
alternative benefit protection.

Summary Of Agreement Rules

The following table shows whether your work is covered under the U.S. or Norwegian Social Security system. If you are covered
under U.S. Social Security, you and your employer (if you are an employee) must pay U.S. Social Security taxes. If you are covered
under the Norwegian system, you and your employer (if you are an employee) must pay Norwegian Social Security taxes.
"Certificate of coverage" section explains how to get a form from the country where you are covered that will prove you are exempt
in the other country.

Your work status Coverage and taxes

You are working in Norway:
for a U.S. employer who:

U.S.
© Sent you to work in Norway for five years
or less
Norway
© Sent you to work in Norway for more than
five years
Norway
© Hired you in Norway
For a non-U.S. employer Norway

For the U.S. government and you are a:

U.S. (either Social Security or federal

* US. national retirement program

Norway
© Norwegian national
You are working in the U.S.:
For an employer in Norway who:
Norway
© Sent you to work in the U.S. for five years
or less
U.S.

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