U.S. retirement benefits normally need 40 quarters (10 years) of credits. If you split a career between the U.S. and Italy, you might fall short in each country alone. As long as you have at least 6 quarters of U.S. credits, the agreement lets you add your Italy credits to reach eligibility — the U.S. then pays a benefit pro-rated to your U.S. credits only.
A Certificate of Coverage is the document that proves you're exempt from one country's social security. For U.S. coverage, the employer requests it from the SSA Office of Earnings & International Operations. Italy's authority issues the equivalent when Italy covers you.
Under the U.S.–Italy agreement, a worker sent by a U.S. employer for 5 years or less normally stays under U.S. Social Security only and is exempt from Italy's system. Your employer obtains a U.S. Certificate of Coverage as proof. Beyond 5 years, coverage shifts to Italy.
Yes. If you have at least 6 quarters (about 1.5 years) of U.S. credits, the agreement lets you combine ("totalize") your U.S. and Italy credits to reach the 40-quarter (10-year) threshold for a pro-rated U.S. retirement benefit.
The agreement has been in force since 1978.
Pension taxation depends on Italy's domestic law and the separate U.S.–Italy income tax treaty (if any), not the totalization agreement. The totalization agreement only governs which country's social security system covers you and how credits combine. Confirm pension taxation with a cross-border tax advisor.