Permesso di Soggiorno

Your visa is the right to enter Italy for reasons other than short-stay tourism. The permesso di soggiorno is the right to stay in Italy.

Even if you have been to Italy many times, obtaining a permesso is likely to be quite different from any process you have been through in Italy before. You might have visited an Italian post office to mail a letter, for example, or to buy stamps. But you have probably never had to obtain and submit documents through the post office. Neither, most likely, have you ever visited an Italian police station. Obtaining a permesso and renewing it will require you to become familiar with both these places.

Unlike people working in the tourist industry, many of the people that you will encounter during this process will have only limited knowledge of English. If your Italian is not fluent, try to have an Italian-speaking friend accompany you, at least on your initial visits.

Whatever your command of the language, make sure you understand the process and have all the relevant documents ready for inspection.

Applying for a Permesso di Soggiorno

Under Italian law, you must apply for a permesso di soggiorno within 8 days of your arrival in Italy. Kits for putting together this application are available from your local post office.

Post offices are used for many more functions in Italy than in the United States – bill paying, banking, even package delivery, as well as legal documents such as the permesso. As a result, Italian post offices are often very busy.

Many post offices have machines near the entry which will give you a ticket with a number. In smaller post offices, you can go to any window for any function. In larger post offices, however, you may need to specify at the ticket machine what function you are looking for.In some post offices, you need to go to a special window for the permesso called a sportello amico. If your post office does not offer such a window, select a ticket for “all other functions.” If they don’t have the kits, they may direct you to another post office.

If you are moving into a large city, you can search the Poste Italiane website for post offices near you. Under the “servizi” section, you can check to see whether a sportello amico is avaialble at that branch.

In post offices with a multi-function ticketing system, your ticket will have both a letter and a number. There is often a small electronic board which indicates which ticket numbers are being served, and at which window.

Occasionally the local post office will be out of kits. Usually, it is better to go to another post office rather than waiting for the original post office to re-stock.

Since completing the application process can be confusing, we recommend that you obtain the permesso kit prior to moving to Italy, e.g., on a house-hunting trip. This will allow you to complete the form and collect the required documents at your leisure, without worrying about the 8-day time limit. Otherwise, you should obtain the kit as soon as possible upon your arrival in Italy.

Unfortunately, the application form for the permesso is not available online. You can find facsimile forms online, which can be useful as a guide, but exercise caution because the forms change frequently.     

Completing the Application Form

The kit will include an application form and will contain a list of documents that you will need to bring to the post office when submitting your application.

The application form is not especially difficult, but can be challenging depending on your knowledge of Italian and your comfort level in using an Italian dictionary (or even better, an Italian-speaking friend) for assistance. You can also find some instructions (in English) for completing the form on YouTube.

If you are entering Italy under an elective residency visa, you will only have to complete Part I of the application form.

If you are a married couple, you will need to complete an application form (and pay the requisite fee) for each person.

DO NOT sign and date the application. You do this in front of the post office representative when you submit the application.

Other Documents

In addition to the application form, you will also need to bring other documents with you when you submit your application, as specified in your kit. These include:

  • Your passport, endorsed with the visa issued by the consulate
  • A photocopy of every page of your passport, including all the blank pages
  • Proof of health insurance (plus photocopy for mailing)
  • Documents relating to why you are in Italy, including your lease or proof of residential property ownership (plus photocopy for mailing)
  • Copies of the financial information you submitted for your visa
  • Envelope for mailing documents to immigration office (included in the kit)
  • Marca de bollo plus money for other fees (see below)

Application Fees

There are several fees associated with applying for the permesso di soggiorno:

  • Fee for the permesso (70.46 or 80.46 euro depending on length of stay requested)*
  • Fee for the post office (30 euro)
  • Fee for the marca di bollo (16 euro)

These fees are not listed in the application kit and are subject to change – you should check online before you go to the post office to submit your application.

The fee for the permesso is based on the duration of the permesso you are requesting: 30.46 euro for the issuance of the card, plus either 40 euro for a one-year duration, or 50 euro for two years. Different regions have different policies for the durations permitted: some will issue a 2-year permesso to new residents, some will only issue a one-year permesso initially but will permit a two-year duration on renewal, and some will only issue the permesso for one year at a time. If you have friends in your comune who have been through the process, you may be able to determine what the policy of your comune is. Keep in mind that if you request (and pay for) a two-year permesso and your comune will only issue a one-year permesso, you will not receive a refund.

You can obtain the marca di bollo at any tabaccheria (recognizable by large T signs). The other fees are paid at the post office.

Note that some but not all post offices will accept credit cards or local bank debit cards. It is safer to bring cash.

Note that the fees are per person, so if you are a married couple you need to double all of these amounts.

Submitting the Application

Once all your documents are ready, and in any event within 8 days of your arrival in Italy, you must submit them at the post office. You should follow the same procedure you used to pick up your kit, e.g., if you needed to use a special sportello to pick up your kit, you should submit your application at the same sportello.

The post office employee will check your passport, have you sign and date the application forms, collect your fees, and put your documents into the envelope to be send to the immigration office.

Most of the websites we have reviewed suggest that you include photocopies of all required documents in the packages sent to the immigration office. In our area (Ascoli Piceno) we were advised that we needed include only the application forms and the photocopy of every page of our passports (including the blank pages). This seemed to work – we were not asked for the other documents until we had our appointment with the questura. Practice may vary by comune; if you are unable to determine what specific policies are followed in your area, it is safer to

Once you have completed the submission process, the post office will issue you an appointment date for the questura (police station). They will also issue you an official receipt that you have submitted your application.

Important: Keep your receipt, which will operate as your temporary permesso until the actual permesso is issued.

The length of time between the date you submit your permesso application at the post office and the questura varies by region. In some areas, appointments are scheduled only a couple of weeks out; in other areas, the delay may be several months. However, as long as you have your receipt, which is your proof that you have applied for the permesso, you have the right to remain in Italy.

Your Appointment at the Questura

When you go to the questura, you should bring the following:

  • Your passport
  • Proof of health insurance
  • Documents relating to why you are in Italy, including your lease or proof of residential property ownership
  • Copies of the financial information you submitted for your visa
  • 4 passport-size photos

Once again, you should bring the originals of all relevant documents (for inspection) and photocopies (to submit for your file). You do not need to bring another photocopy of your passport.

You can obtain passport-size photos at public photo machines; these machines can usually be found close to the questura, although they are generally found in other commercial areas as well. These machines issue photos in two different sizes – be sure to select the size designated for the permesso di soggiorno. The pictures are inexpensive (5 euro for 4) and take only a few minutes to create.

The immigration office at the questura can be a bit chaotic. In some areas, people are seen based on the order of their appointment. In other areas, everyone with an appointment for that date is seen on a first-come, first-served basis. In some offices, you keep your documents with you until your name is called. In others, you put your identifying documents (your appointment care and your receipt) in an in-box which is then collected by someone in the office. In any event, you should not arrive later than your appointment time, and even in a questura which follows appointment times you may have to wait.

When your name is called, you go up to the sportello with your documents. Husband and wife can go up together. The police officer at the sportello will then ask to see whatever documents they consider relevant. They may not ask to see everything — in our case, for example, we had to provide our lease, but not our financial statements or proof of health insurance. Still, it is safer to bring all the documents required, since you don’t know what the reviewing officer will ask for in your situation.

Once your file is reviewed, you may be asked to wait while they complete your application. You will be asked to sign an integration agreement, which requires you to attain an A2 language certification within 2 years, and to attend a citizenship course. (In our case, we were told to report to a course given at a local school, but you can take the course elsewhere if the dates are not convenient.) Finally, you will be fingerprinted at the questura, and the fingerprints will be submitted with your file.

When this process is complete, they will return your receipt (which is still acting as your temporary permesso) and assign your file a tracking number. You can check the status of your application, either on a website run by the polizia de stato or one run by the post office, using your tracking number. In many cases, if you provide a local phone number, they will send you a text message when your permesso is ready.

Waiting Period

The waiting period between the date you submit your application at the questura and the date your permesso is issued varies by comune. In some areas, it can be issued in as little as 6 weeks; in others, the wait can be as long as six months. Although the process is not totally transparent, it appears that the difference in wait times is the result of staffing issues – how many people are available to review documents in your region relative to how many people are applying, rather than any problems with specific applications. Check the website periodically to ensure that it indicates that your application is still in process.

You should carry your receipt, which acts as your temporary permesso, at all times while you are waiting for your permesso to issue – it establishes your right to remain in Italy. You can also use your receipt acts to establish residency, apply for the health care system, etc.

There may be an issue if you want to travel outside the country while your permesso is still pending. If you travel within the Schengen zone, there are generally no passport checks at the borders. However, if you want to travel outside the Schengen zone, e.g., to the US, you may experience difficulties upon re-entering Italy, particularly if you enter through another EU country. The receipt for your permesso application acts as a temporary permesso for many purposes within Italy, but it is not necessarily recognized as such by other countries. It is safer to postpone any foreign travel until after your permesso has issued.


This site derives from the personal experiences of a group of US expats and Italian citizens who independently chose to live in Ascoli Piceno, Italy. Some of the posts here might apply to Ascoli Piceno and not other provinces; we’ll try to call those out. But as with anything in Italy, things are different in different provinces.


It is sometimes said that tax evasion is the Italian national sport. Seriously, taxes in Italy are high and it is often difficult to determine what you owe. There can be wide variance of opinion on the latter topic. Your will almost certainly want to arranges for the services of a local tax accountant (commercialista).

If you live in Italy for more than 183 days in a year and received any income, you almost certainly have to file an Italian tax return as well as a US one (assuming you’re a US citizen). If you are a resident, Italy taxes your worldwide income. One of the primary means for determining residency is registration in a comune. So, before you depart Italy for a long period of time you should think about unregistering from your comune, or registering in A.I.R.E. (registry of Italian citizens abroad) if you are an Italian citizen.

Here are the Italian taxes that we know about.

IRPEF (‘Imposta sul Reddito delle Persone Fisiche’)

IRPEF is the standard Italian progressive income tax. It applies to earned income, passive income from activities such as property rental, and pension income (including IRA distributions). The tax rate is based on income starting at 23% and topping off at 43% for income above €75000. Taxes are computed per individual. There is no concept of joint filing. There are a small number of allowable deductions from taxes owed, for example a certain percentage of medical expenses. Tax paid to other countries is also deductible.

Estimated IRPEF payments of 40% and 60% are due for the current tax year on 30 June and 30 November (of 2020 for tax year 2020), or the next subsequent business day in the case of a weekend. Accounts are settled between estimated and actual payments when filing the yearly return in the subsequent year (as in the US).

There are regional and city taxes amounting to maybe 2% depending on location. These are incurred along with IRPEF on the same income.

Substitute Tax (on passive income outside of Italy)  

Passive investment income (interest, dividends, capital gains) generated outside of Italy is generally taxed at 26%. Certain types of income (on government bonds) are taxed at a preferred rate of 12.5%. Payment of this tax is on 1 July of the following year, there is no estimated payment in advance. There are no deductions, including payment of tax to other countries. You should probably check with your commercialista about which types of US investments are eligible for the substitute tax rate rather than the regular income rate.

Ideally, income earned and capital gains should be reported at the exchange rate of the date of transaction. This makes bookkeeping a bit of a pain, and it can make a big difference for capital gains and losses, since these must now also account for currency fluctuation.

IVAFE (‘Imposta sul valore delle attività finanziarie detenute all’estero’)

IVAFE is a wealth tax on financial assets held outside of Italy. The holder must pay 0.2% of the value of those assets at the end of the calendar year. Estimated payment is made on the same schedule as IRPEF.

IVIE (‘Valore degli immobili situati all’estero’)

Italy taxes property owned abroad at 0.76%. However, if tax on the same property is paid to a foreign state, those payments offset IVIE. The basis on which IVIE is charged is a bit murky. If you can prove the price you paid your house, that can be the declared valuation for IVIE. Otherwise your basis is market value, whatever that means.

TARI (‘Tassa sui Rifiuti’) 

Comunes tax businesses and residents for garbage collection. For residential property, the rate is based on the registered size of the dwelling. TARI in Ascoli is due in 3 installments starting in April. For a huge apartment, the rate is a bit under €600 per year.

Retirement accounts (IRA, 401k) 

The taxation of US tax-deferred retirement accounts is not well-defined in Italian law. There are two schools of thought. The first is that IRAs are taxed similarly to Italian previdenza complementare (supplementary pensions). In this scheme, income arising within an IRA account is taxed at a 20% rate while the beneficiary is retired but not receiving distributions, and then distributions are taxed at the IRPEF rate excluding what has already been taxed. The other interpretation is that distributions from such accounts are taxable at IRPEF rates as regular income, but that income within a IRA or a 401k is not taxable. The taxing authority has not yet opined about which treatment is definitive. Don’t hold your breath.

Similarly, there is an open question about whether pension accounts are subject to IVAFE. The reigning opinion is that they are not. But again, there is no certainty.

There is no Italian analog for a Roth IRA account. It would probably be wrong to assume that income in such accounts would remain tax-free in Italy.

If you are employed in Italy and trying to contribute to a retirement account, we can’t help you.

VAT (Sales Tax)

VAT is incorporated into the price of everything you buy. There are various rates, but the most common is currently 22% (the rate for groceries is less). VAT applies to professional services (realtors, accountants) as well as physical products. In most situations, the shelf price or the menu price includes VAT. For professional services, the VAT is usually added afterwards.

Tax Treaty

There is a tax treaty between the US and Italy to prevent double taxation. Rendering the language of this treaty into the boxes of an IRS form is not a trivial enterprise. Among other things, it says that certain US pension income (for example Social Security income) is taxable only by the country in which you are residing. In order to get relief under the tax treaty, it is sometimes necessary to treat income earned in the US as if it were earned in Italy (because the US only allows credit for tax paid on income earned in Italy). Things are made more complicated by the fact that the Italian Substitute Tax does not allow deductions for US taxes paid. The bottom line is that this stuff can be tricky, but it is workable.

Since Italian taxes are generally higher, many retirees pay taxes to Italy (first) and then file a net zero return in the US (later).

Filing and Paying Taxes

The Agenzia delle Entrate is the Italian version of the IRS. This office collects money for all sorts of government functions including taxes and voluntary healthcare inscription fees.

Income taxes are reported electronically to the Entrate using one of two methods: the Modello 730 or the Redditi PF (Unico). The two forms have different deadlines: 23 July and 30 September, respectively. The former seems commonplace for working people with regular incomes. The latter is more common for folks who have foreign income and other unusual situations (like US expats).

Your commercialista can help you file these tax forms. In Ascoli, several of us use dott. Giorgio Marilungo (, a reputable and friendly commercialista who is used to dealing with expats with minimal shared language.

Taxes are paid using a form F24 digitally sent from your bank account (or post office). You can do this yourself, or delegate your commercialista to do it for you. The relevant payment dates are 30 June and 30 November. The filing deadline for the PF form is 30 September, but you have to pay any difference between estimated and actual taxes by 30 June to avoid penalties.


Before discussing how the power distribution system works, it is important to be reminded that in Italy voltage is 220 and frequency 50. Voltage is critical and before plugging in any appliance, one needs to make sure that it is compatible. Some appliances, such as telephone chargers, are self-adjusting, while others, such as some curling irons, need to be mechanically set via a switch. Others are not compatible at all. This is common for some electronics that manufacturers do not want distributed outside the US. Plugging in an appliance set for 110 v. into a 220 v. outlet will destroy it and possibly cause fire. Plugs are different, but you probably already knew that.

Frequency is nowadays of lesser importance, unless you are planning to bring along your old record player. Frequency mostly affects electrical motors.  Higher voltage requires thinner wires, so do not be surprised if electrical wires in Italy are smaller. On the other hand, 220 v. gives a much stronger shock, so be careful handling electrical equipment.

Power Companies

In the past, there was a single State-run power company ENEL or ‘Ente Nazionale per l’Energia Elettrica’ (National Agency for Electricity). After deregulation, power distribution was assigned to the ‘Servizio Elettrico Nazionale’ (Electrical National Service) which takes care of distribution. Production is a combination of private, publicly controlled and foreign sources.  Consumers can choose among a large number of providers (18 at my last count).   These providers just sell you power and they do not even install a meter since those are provided by the grid.

No matter where you shop, power is expensive due to high taxation. These are average costs in an electrical bill:

  • Electrical Power (47%)
  • Delivery cost and metering (20%)
  • Indirect taxes (19%)
  • Other taxes (14%)

Other taxes will include the Canone TV License fee. This fee is charged to everyone owning a television, and the assumption is that you do.

In our experience, using ENEL Energia is the easiest choice and they have an English version of their web site. This company was born from the splitting of the old public company. They are by no means the best; they are just the largest.

Getting Service

Regardless if you rent or buy, electrical service should already be preset. The only question to ask is how many kilowatts are available to you. In the US, we are more used to describing service by Amps. An electrical panel in the US is usually 100 Amps or more, which would be about 8 kilowatts.  In Italy, meters start as low as 1.5 Kw with an average house having 3.0 Kw and a larger one 5 Kw. You will quickly learn not to run the dishwasher, vacuum cleaner and hair dryer at the same time. Upgrading a meter to a higher Kw is done remotely, but it is very expensive (about €300 to go from 3 to 5 Kw).

Invest in low energy light bulbs (LED) and avoid electric heaters.

To obtain service you need to complete a ‘voltura’ or transfer of registrant. Let your real estate agent take care of it since it is complex.  If you want to do it yourself, you will have to provide:

  • Your tax ID code (Codice Fiscale).
  • The POD code or Eneltel ID no. of the meter (for an electricity supply) or the PDR code (for a natural gas supply). You will see this on the tag attached to the meter or on the meter itself by using the digital display.
  • The meter reading.
  • The form declaring ownership or rightful possession of the property for which the electricity or gas supply is requested (certificate of residence).

You can do it over the internet but will need a scanner to send copies of your documents or you can do it in person at one of the local offices. The process may easily take a month or more from beginning to end. Meantime, service is still provided and the invoice is sent to the old registrant. Make sure you find these old invoices because they contain a form that you will need to take to a payment center (tobacconist or Post Office) in order to pay it.

The easiest way to handle payments is to have the ‘docimiliazione’ or automatic withdrawal from your checking account.   Alternatively, every two months – that is the frequency of the invoice – you have to go to one of the outlets (NEL stores, banks, post office, betting offices, etc.)  and manually pay it along with a transaction fee.

Variable Prices

Most contracts call for variable prices based on the time of the day. In general, they fall under these guidelines:

With a high rate from 8:00 AM until 7:00 PM Monday through Friday and a lower rate at night and weekends. There are no special rates for holidays. Over time, doing laundry or using the dishwasher after hours pays back.

What if You Do Not Pay?

In Italy, the power company cannot completely remove service. If you fail to pay, they will leave you 15% of the original Kw available (usually 450 Watts, just enough for the refrigerator and lights). Getting power reconnected is tedious, so keep up with your payments. If you have a disability, get registered as  disabled so that the power company cannot disconnect service.

Web Portal

All companies have a portal that you will use to manage your account. It is very important to sign up and gain access to this portal because the only alternative is a phone call to a call center and a long wait. The first time, you will ask your Italian friend to call the power company on your behalf. (Do not be surprised if they fake a sudden illness.)  As already said,  ENEL provides quite a bit of information in English.


(Most everyone needs to get around. If you live in a large city, public transportation may be all you need. However, life in small cities or the countryside often requires the use of a car. Here’s some basic information on both. Keep in mind that much of what’s written here pertains mostly to our corner of Le Marche, and that, as with many things, your experience may be quite different in different parts of Italy.

Health Care

National Health Care System (‘Servizio Sanitario Nazionale’) 

Italy has a national health system, similar but not identical to the one used in the UK, France and Spain.  Other European countries, including Germany and Switzerland (and the ACA, for that matter) use a government-regulated insurance approach.

In Italy, all citizens are automatically enrolled in the national health system.  Legal Italian residents who are citizens of another EU country are also entitled to use the health care system under EU reciprocal agreements. Certain family members of those in the previous two categories are also eligible. Legal residents from other countries are allowed to buy into the system.  Premiums are income-based, and range from €400 to €2700 per person per year.

Coverage is comprehensive, and includes things like rehabilitation services which are often treated as supplemental services in the US.  There are no deductibles, and for new registrants, there are no exclusions for pre-existing conditions.  Public system doctors do not make house calls, but the system does provide transportation for the elderly or others in frail health who are unable to get themselves to a treatment facility.

Co-Pays and Other Costs

Coverage includes an unlimited number of visits to your primary care physician, without co-pays.

There are co-pays for certain items like annual blood tests. Co-pays are subject to a statutory maximum, currently €46 (about $50),  but depending on the test can sometimes be less.   Co-pays are waived for those on limited incomes, or for those in certain medical categories like cancer survivors.

Co-pays also apply to consultations with specialists.  If you get a referral from your primary physician, and are willing to take the next available specialist, you pay €46. If you make the appointment on your own, or you want to see a specific doctor, you pay €100 (about $110).

There are no co-pays for emergency room or hospital services.

Mammograms are free every two years.  If you (or your doctor) want them more frequently, you can schedule them, subject to the standard co-pay.

Drugs prescribed for active conditions (e.g., antibiotics for current infections) are free.  Maintenance drugs are either free or low cost (see “Medications” below).

System Administration

When you are enrolled in the system, you select a primary care doctor who is generally your point of entry.  If you don’t like your doctor, you can change without cost or penalty (although you will have to wait in line at the administrative office).

The system is administered locally.  Within each region, there are smaller administrative areas which ensure that most of your medical care will be provided for by practitioners close to where you live.  In our case, our primary care physician is a 10-minute walk from our house.  Our primary hospital and emergency room is a 10-minute drive from our house, or 20 minutes by bus (served by three bus lines).  Within walking distance from where we live, there is a satellite center for blood tests and immunizations, so you don’t have to go all the way to the hospital.  There is also a small private hospital within walking distance where you can get some services at additional cost.

Although your primary care physician is located in your area, you can actually go to a public system doctor anywhere in the country.   If you want to see a knee specialist in Perugia or a heart specialist in Rome, you are covered, subject to co-pays and availability.  If you have a rare condition and the only available specialist is in another city, the system will cover your train ticket.

The system is set up for efficiency, which is not necessarily the same as convenience for the patient.  If you are very sick, or have a medical emergency, you will be seen quickly, for example only a few days between cancer diagnosis and treatment.  On the other hand, if you go to your doctor with an important but not urgent medical problem, you will probably sit for 2 hours in your doctor’s waiting room.  Most primary care doctors here practice individually, with at most a nurse assisting.

Waiting times for non-urgent specialist consultations, or non-urgent medical procedures, like “extra” mammograms or colonoscopies, can sometimes be months long. If the appointment is truly non-urgent (e.g., you want a second medical opinion to confirm a prior medical conclusion) you may not mind the wait.  And you can sometimes get an appointment quicker if you are willing to go to another doctor in the region, which can be an hour or two away.  Or you can go to a private doctor.

Private System as Supplement

One of the most interesting features of the Italian medical system is the way you can go to a private doctor or a private hospital on a one-off basis, even though you are covered by the national health care system.  This is not the case in the UK (or the US for that matter), where you are either in the public system or the private system, but you generally can’t utilize both systems at the same time.

So, for example, if you want a colonoscopy, and don’t want to wait months for a hospital appointment, you can make an appointment for the same procedure at a private hospital, generally with a much shorter waiting time.  Similarly, if you want a specialist consultation in weeks instead of months, you can pay for a private doctor.

Private facilities also provide services for the public system on a contract basis.  A friend of ours had minor surgery at the local private hospital, which was fully covered by the public system.  Private facilities also provide diagnostic services for the national health system on a space available basis.

There are also some doctors who have both public and private patients, with shorter wait times (and higher fees) for the private patients.

The reason why this back-and-forth between the public and private systems works is that the costs, even at most private facilities, are very reasonable  The cost of a mammogram from a private doctor, for example, is 80 euro.  A consultation with a private surgeon is €150.  And the cost of a colonoscopy at the private hospital was €130.  These costs are not only reasonable for us as Americans, used to paying staggeringly high prices, but they are also within the means of middle-class Italians.

We think that most people in our area use the public health system for most of their medical needs.  People in certain situations might use private doctors for primary care.  People with chronic medical conditions, women expecting a baby, or working parents with small children, for example, often prefer the convenience of being able to make an appointment.

With respect to major medical services, though – surgery, broken bones, treatment for cancer or other serious illnesses –  it seems that most people, rich or poor, use the public system.

Registering for the SSN

As stated above, the SSN is administered locally, so each region (or sub-region) will have it’s own processes. In Ascoli, the administration function for SSN enrollees is performed at the Anagrafe Assistiti in an office at the main hospital, but the acronym ASL (Agenzia Sanitaria Locale) is more generally used to name this office. The office handles SSN signups, choice/change of doctor, and exemption on co-pays (tickets) for people of lesser means.

Italian citizens and family members of citizens are eligible for Iscrizione Obbligatoria (gratis enrollment), and most likely will not have to visit this office again except maybe to change primary doctors (medico di base).

Folks who are not family members of EU citizens must sign up for Iscrizione Voluntaria. There is a form that you will need from the ASL. This form does not appear online as far as we can tell, so you will have to go there or find someone else with a copy. Payment is made according to the formula below. Income in most regions is self-certified and is intended to include worldwide sources. (Some regions require official income certification, which causes those folks serious pain.)

7,5% of total income up to €20,658.28 plus 4% of the amount exceeding €20,658.28 up to €51,645.69, and in no case less than €387.34 .

Payment is for a calendar year. It is not possible to pay in advance, and there is no pro rata reduction for a partial year. Payment is made by F24 form, the same form using which income tax is paid. But you need to include the specific coordinates for your regions SSN. Our ASL is known to be picky in that an “original receipt” must be shown for the electronic F24 payment. We suggest that you go to your bank to make the electronic transfer and ask the clerk to produce an official receipt. Actually, ask for two official receipt (see below).

You must provide your Carta d’Identità or other proof of local residence, and your Permesso or Carta di Soggiorno. Your SSN enrollment will be valid only until the expiry of your Permesso/Carta, so you may need to return to this office after any renewal. Renewal receipts are supposed to be sufficient, but this is Italy, so you can’t be sure. The ASL may also ask you for another “original receipt” of payment like the one you submitted at the beginning of the year. So, it’s best to ask for two when you make your payment at the bank.

Once you have your payment receipt, you can go back to the ASL to complete the signup.

Choosing a Doctor

Choosing a medico di base is not easy given that the rolls are fairly full and that there is not much to go on. The best method may well be to get a recommendation from someone you trust. Keep in mind that there is a mandatory retirement age, so if you sign up with an older doctor, you may be choosing again in a few years.

Doctors have a lot of flexibility when it comes to organizing their practices. Some practice in small groups. Some schedule appointments. Some have assistants, some don’t. But it is most common, at least in Ascoli, for doctors to offer office hours, usually for a few hours a day. You go to the office, ask “Chi è l’ultimo?” and wait. You may want to choose a doctor best suited to your tolerance for waiting. Bear in mind that the amount of attention that a doctor may choose to spend helping you may be proportional to your wait time.

Using the SSN

After visiting the ASL, your first experience with the SSN will probably be with your chosen medico di base. After waiting for your turn, your doctor will probably talk to you, maybe take your blood pressure, and then order a battery of tests. For blood tests, you can go to a local centro prelievi. In Ascoli, the ASL operates one at ex-Gil and one at the hospital. You will supply the co-pay first, of course. Private facilities are possible as well, although those might cost more. Your results will be available at the same location, or online.

For specialized tests, for example an ECG, you need to go to the CUP (Centro Ufficio Prenotazione). In Ascoli, that is at the hospital. (They are currently experimenting with allowing appointments to be made online or at pharmacies.) When you return to the hospital for your test, be prepared to pay in advance at the CUP or just afterwards. Policies differ. And of course, you can always go to a private facility instead. Or, the CUP might send you to a private facility for your test at the public rate.

Quality of Medical Care

The quality of the medical care is difficult to judge for those of us who are not doctors.  But the SSN doctors seem attentive and well-informed.  In cases where we have had the same procedure done both in the US and here, our experience here was better.

Many procedures done by physician assistants or nurses in the US are done by doctors here.  In the US, when a test is done by a medical tech, the technician is often prohibited by law from discussing the results of the test with the patient.  In Italy, when tests are done by doctors, they write up and discuss their results with you in real time.

In our experience, doctors, or at least medici di base, are a lot less “hands on” than doctors in the US. They rely a lot more on looking at test results rather than examining you physically.

In the Italian medical system, test results, whether in a public or private facility, are typically immediately available and are your property.  This puts the responsibility on you for maintaining your personal medical records – you often see people in doctor’s offices carrying around thick folders with their medical history.  But it also means that if you change doctors or move to another region, you don’t have to struggle to get copies of your medical records.

Private Insurance

Private insurance is available, and is generally not costly, but in my region, at least, it seems that few people use it.


Certain specialties are not well-covered in the national health service, but you can find excellent service in private practice. Here are some details specific to Ascoli Piceno.

  • Dental service, at least in Ascoli, is excellent in our experience. At least as good at the US if not better, and an approximately half the cost. We recommend Dr. Gino Chiodi on Via Cola d’Amatrice.
  • Again, we have found opthamalogical service here to be on a par with that in the US. Eyeglasses, however, seem to be more expensive. We recommend dott.ssa. Stefania Aliberti on Via Marcello Federici.
  • Dermatology specialists are hard to find in the SSN. We have had good luck with dott. Massimo Cioccolini who is in private practice on Via Erasmo Mari.


Doctors can issue two types of prescription. One is directly in the SSN computerized system allowing you to pay the “ticket” price for the medicine, which is close to nothing. Such prescriptions are typically for limited duration: 2 months at most. Or your doctor can hand-write a prescription outside the system for up to 6 months. In this case, you pay full freight which is not usually very much. This can save time waiting in the doctors office. For example, a common statin costs €6 per month.

Vaccines (especially flu vaccines) are sometimes available at doctors offices, but çan often be available directly at pharmacies (at reasonable cost). A pharmacy may or may not be equipped to administer the vaccine. It is not so uncommon for people to give shots at home.

Painkillers are less widely used here, whether by prescription or OTC.  Doctors here use painkillers for pain reduction, not pain obliteration — increased pain is a symptom they don’t want to mask. There are drug abuse problems in Italy, but there doesn’t seem to be an epidemic of opiate abuse.

  • European equivalents to Common US over the counter drugs 
  • Importing special drugs 


This section covers a number of important services for homeowners and renters alike.

One thing most of these services have in common is that you have to regularly pay for them. Some providers allow payments using credit cards. All of them accept payment using bollettini postali at the Post Office. But in general, if you have a bank account, you might find it easier to pay using direct debit from your conto corrente. Not only is there no charge for this, but you don’t run the risk of falling into arrears. Although utility bills arrive quite late in the cycle by American standards, they often allow relatively little time for payment.

The Codice Fiscale

The Codice Fiscale is the Italian tax ID number, and is used for a variety of purposes in Italy, including obtaining health insurance and opening a bank account. Anyone who has legally entered Italy can obtain a codice fiscale – you don’t need to have signed a lease or filed a tax return.

If you are seeking an Elective Residency visa and don’t already have property in Italy, you will need to present a signed copy of your lease or rental agreement at your consular appointment, together with proof that your lease has been registered with the Agenzia delle Entrate. To register the lease, even if your landlord does it for you as is usually the case, you will need to obtain a Codice Fiscale.

To obtain a Codice Fiscale you should go to the local office of the Entrate. You will need your passport (or residence permit or Carta d’Identità if you have them already). You can generally complete the application and be assign ed a number on the same day as your visit. (If you are working with a local realtor, they can help you with this process). The Entrate will eventually send you a plastic card evidencing your number, but you can start using the number right away. (According to the official website, the Codice Fiscale can also be obtained at the Sportello Unico per l’Immigrazione at the Prefettura. We haven’t tried that.)

The Codice Fiscale is actually computed using an algorithm applied to your name and birthdate and place of birth. Merchants can verify the data you enter, for example to a website, to check if the codice you entered is correct. For this reason, if you need to enter a Codice Fiscale anywhere in addition to your name, be sure to enter the same exact name, including middle name, that you used for registering for the Codice Fiscale.

Important Note: In order to apply for the Codice Fiscale, you will need to demonstrate that you have legally entered Italy. The easiest way to do this is by showing a passport stamp issued by an Italian border official. If you entered the EU through another country (e.g., Germany) you will not have an Italian stamp in your passport, because there are no border controls within the EU. The Entrate will not accept a passport stamp from another EU country for this purpose, and you will have to first register your entry into Italy at the local questura (police station). To avoid this frustrating additional step, we strongly advise arranging your trip such that you enter the EU through Italy.

Elective Residency Visa

The elective residency visa is designed specifically for persons (especially retired persons) who wish to reside permanently in Italy and have adequate financial resources to do so. The elected residency visa is not designed for extended tourism, but for those who intend to establish a permanent home in Italy. Individuals who receive this visa cannot work in Italy – they must be able to sustain themselves from their existing financial assets. You must obtain the Elective Residency visa in the United States. You may not enter Italy as a tourist and seek to extend your stay by obtaining an elective residency visa from Italy. The Elective Residency visa is valid for exactly 365 days, and may not be renewed. You must convert it to a “permesso di soggiorno” (residence permit) once you arrive in Italy.

Obtaining an Elective Residency visa

In general, obtaining an Elective Residency visa requires an interview with the appropriate consulate, and the presentation of required documents.

Consular Jurisdiction

You must present your documents at the appropriate consulate, depending on where in the U.S. you reside. Note that the appropriate consulate may not necessarily the one closest to your residence. Here is a list of Italian consulates in the USA and their jurisdictions.

Required Documents

Once you have identified the appropriate consulate, you can find the requirements for the Elective Residency visa on the website for that consulate. Each consulate has its own list of requirements, which
differ slightly. IMPORTANT NOTE: These requirements change frequently and often without notice. You should check your consulate’s website not only when you begin the process, but at regular intervals thereafter, to make sure requirements haven’t been changed or added.

General Requirements: These documents are required by all consulates
  • Valid US passport. Most consulates require the expiration date be at least three months after the expiration date of your visa. Since the visa is for one year, that means that your passport must have an expiration date no sooner than 15 months from the the start date on your visa.
  • Your passport must at least one blank page (or, for some consulates, two blank pages) for affixing the visa.
  • Proof of physical residence in the consular jurisdiction, e.g., driver’s license, state ID, utility bill).
  • Passport-sized photograph (check specific dimension and other requirements on your consulate’s website)
  • Long stay visa application (form available on the consular website)
  • Lease, rental contract of deed for property in Italy, in your name. If you are a married couple, the lease should have both your names on it.
  • Proof of sufficient financial resources: bank or brokerage firm statements, copies of pension of social security checks, other sources of income.
  • Letter stating why you want to move to Italy, where you will live, and who is moving with you ((e.g., spouse or children)
  • Declaration for Mailing Passports (form available on the consular website); this authorizes the consulate to mail your US passport back to you once the visa has been affixed.
  • Self-addressed pre-paid US Express Mail envelope which the consulate will use to return your passport; the consulate will not accept regular US mail envelopes or envelopes from couriers such as Federal Express.
  • Visa application fee, which must be paid in the exact amount by money order made out to the Consulate General of Italy. The fee (approximately $140 as of spring 2019) adjusts every three calendar months based on the government’s official exchange rate.
Certain other documents are required by some consulates and not others:
  • FBI criminal background check
  • Proof of overseas health insurance
  • Flight reservations
  • Certified copy of marriage certificate (if traveling with spouse) or childrens’ birth certificates (if traveling with children); note that these documents will be required in any event to obtain the permesso di soggiorno.
  • Although most of these requirements are straightforward, some require additional explanation
Document details:

Financial Resources: Since this visa does not allow you to work in Italy, you need to demonstrate to the satisfaction of the consular official that you have enough resources to support yourself in Italy. Some consulates state only this general requirement; others require you to bring specific documents such as bank statements for the last six months, tax returns for the last six months, or letters from your bank financial advisor, or accountant. If you are receiving Social Security or pension checks, you should bring evidence of those.

Unfortunately, there is no hard and fast rule for how much income is enough to meet this requirement, although the Los Angeles consulate suggests a minimum income of $3,375/month for a single applicant.
In general, fixed sources of income, like Social Security and pension benefits, are preferred to variable ones, like income from investments.

Registered Lease: The housing requirement has changed significantly during the last few years. Short-term leases, or contracts to enter into a lease, which were accepted by some consulates in the past, will no longer be sufficient. Unless you already own property in Italy, and intend to live there, you will have to present a signed lease with a term of at least one year during your consular interview, together with proof that the lease has been registered with the Entrata (the Italian tax authority). If you are working with a realtor in Italy, they should be able to help you with registering the lease.

Be sure to negotiate a clause in the lease under which you forfeit only the first month’s rent if for some reason the visa does not issue. In order to register the lease in Italy, you will need a Codice Fiscale (Italian Tax ID number).

Overseas Health Insurance: Some consulates require you to present evidence of a health insurance policy that will cover 100% of your medical expenses in Italy; some consulates have a specified minimum policy limit. Travel insurance policies are generally sufficient.

Even if proof of health insurance is not required by your consulate, it is probably a good idea to purchase short-term health insurance anyway, to bridge the gap until you are able to buy into the Italian health insurance system.

FBI Criminal Background Check: You can order this directly from However, since processing of individual requests can take several months, we recommend that you use an expediter, who can usually provide turnaround of about a week.

You will need a set of fingerprints to begin the FBI background check. In the US, fingerprint services are often available at copy shops or the offices; larger cities may have dedicated fingerprint specialists.

Consular Appointment

You must present your documents in person at the appropriate consulate. Consular interviews are by appointment only, which you can book online. Your appointment date must be within 90 days of your departure date.
For an ER visa, the typical wait time for an appointment is 2-3 months, although that may vary by consulate. When beginning this process, you should check your consulate to see how far ahead appointments are being made so you have an idea how to organize the timing. If your application is approved, the consulate will affix a visa to your passport and mail it back to you. Consular websites indicate this can take up to three months. However, our experience has been that turnaround is much faster — anywhere from 48 hours to a couple of weeks after your visit.

Timing Issues

As you can see from the outline above, getting the required documents in the right order can be a bit of a juggling act. If you are renting in Italy, you will need to get the lease signed and registered before your visa is issued. It is a good idea to start collecting documents about 6 months before your anticipated departure date. You want to make sure that you have all the required documents before the date of your consular interview, especially if your consulate is in another state.

Here is an illustrative schedule, assuming an October 1 departure date:

  • April
    • Check validity of US passport and get passport renewed if necessary
    • Get fingerprints and begin FBI check (if required)
    • Schedule consular interview for July
  • May – June
    • Schedule trip to Italy to select apartment, sign lease, obtain Codice Fiscale; if you are working with a realtor, he or she can help you with these documents. (If you already own property in Italy, obviously you can skip this step!)
    • Collect required documents – note that some documents (like letters of reference from banks or accountants, if required) may take more time than others
    • Periodically check consular website to make sure requirements haven’t changed
  • July
    • Verify current visa fee amount on website (changes at beginning of calendar quarter) and obtain money order
    • Consular interview, with visa dated October 1
    • Visa arrives up to 2 weeks later

Tips for the Consular Interview

The Elective Residency visa is a discretionary visa, which means that they don’t have to issue one to you even if you meet all the requirements. You should indicate, by your manner and the way you present yourself, that you take the process seriously. Dress as you would for a job interview. Arrive on time.

Have all your documents organized and readily available.

Other tips:

  • Don’t put your documents in individual plastic folders. The consulate is likely going to open a paper file on you and they don’t need any more volume than necessary.
  • Order your documents in the order they are listed on the website.
  • Bring the original copy of your lease as well as a copy for the consulate file. You will need to retain the original copy of your lease for a number of purposes in Italy, including establishing residency, obtaining health insurance and opening a bank account
  • You may be able to find sites on the Internet where people share experiences and tips on the consular interview. The value of the tips on these sites varies widely, but you may find useful information, particularly with respect to your consulate.