Italian bureaucracy is fixed. Fixed offices, fixed documents, fixed questions. It has to be, because the same clerks process the same registrations hundreds of times a month.
What has never been written down in English is the order, and specifically what each registration unlocks.
Here is the chain. Eight registrations, in dependency order.
1. Codice Fiscale (Italian tax identification number). Issued by the Agenzia delle Entrate (the Italian tax authority). Required by every institution below. Nothing else in this list can begin without it.
2. Italian SIM card. Required for appointment confirmations and for the identity systems further down the chain.
3. Permesso di Soggiorno (residence permit). Non-EU only, which includes every Elective Residency Visa holder. The kit is submitted through Poste Italiane within 8 days of arrival. Not eight working days. Eight days.
4. Anagrafe registration. Legal residency at your Comune (the local municipal office). The foundation. Almost everything below is blocked until this exists.
5. Carta d'Identità (Italian identity card). Issued by the Comune after Anagrafe registration is complete.
6. Tessera Sanitaria (the national health card) and enrolment with the ASL (the local health authority).
7. SPID (Italy's national digital identity system).
8. Italian bank account.
Read that as a list and it is information. Read it as a chain and it is a schedule. The man who took five months was not missing any of these eight. He was missing the arrows between them.