GN 01702.315 Processing Totalization Insured-Status Notices in Claims for U.S. Benefits

A. Introduction

When an applicant files a claim for U.S. benefits and alleges coverage in a Totalization country, the modernized claim system (MCS) will produce a notice (award or disallowance) containing language that explains the decision on the Totalization aspects of the claim. The following subsections explain the actions necessary to produce a notice, the type of notice that is generated and what information is provided on the notice relative to the Totalization aspects of the claim.

B. Procedure

Take the following actions when an applicant for U.S. benefits indicates the number holder (NH) has coverage in a Totalization country.

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Complete the appropriate retirement, survivor's or disability insurance (RSDI) application screens on MCS.
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Complete the SSA-2490 screens on MCS in life claims if the NH has at least 6 quarters of coverage (QCs) but is not insured. In death claims, complete a paper or electronic (e-form) SSA-2490-BK and the TOTL screen on MCS.
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Process the award or disallowance (see GN 01702.315C).
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Forward the claim to the Office of Earnings International Operations (OEIO) at the address in GN 01702.310C if the NH has at least 6 QCs but not enough to be insured and all other requirements for entitlement are met.
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Forward the claim to the appropriate program service center (PSC) based on the Social Security number (SSN) jurisdiction (or OEIO if at least one applicant lives outside the United States) in all other cases.

C. Process

MCS will produce an award or disallowance notice disposing of the claim. The notice will contain language explaining the decision on the Totalization aspects of the claim as follows:

1. NH has less than 6 QC's

MCS produces a disallowance notice which advises that we have denied the claim because the NH does not meet insured status and we cannot consider foreign coverage because the NH has less than 6 QCs. If claimant has less than 6 QCs, process denial for Title II.

2. NH has at least 6 QC's but is NOT insured

MCS produces an initial disallowance notice which advises that we have denied the claim because the NH does not meet insured status but that we have requested the foreign coverage record and will issue a final notice after we receive it.

NOTE: Failure to process the initial denial in these cases means field office (FO) processing time will continue to accrue pending receipt of the foreign coverage record and final adjudication by OIO.

3. NH insured based on U.S. QC's alone

MCS produces an award notice which advises that we have not considered the foreign coverage because the NH meets insured status based on U.S. coverage alone.

If claimant has at least 6 QCs but is not fully insured based solely on U.S. work, process a Title II initial denial (code 090 in MCS) and forward claim to the appropriate OEIO module.

When the NH has at least 6 QCs but not enough to be insured, OEIO will request the coverage record from the foreign country. Upon receipt of the foreign record, OEIO will convert the foreign credits to QCs, adjudicate the claim and send a final award or disallowance notice, as appropriate, to the applicant.

D. References

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Completing the TOTL screen on MCS, MSOM MCS 009.011
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Completing the SSA-2490 on MCS, MSOM MCS 007.001

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Completing the paper or electronic (e-form) Form SSA-2490-BK, GN 01702.200 - GN 01702-215

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201702315

GN 01702.315 - Processing Totalization Insured-Status Notices in Claims for U.S. Benefits - 02/07/2017
Batch run: 02/08/2017
Rev:02/07/2017

Program Operations Manual System (POMS)