The Icelandic Liaison Agency requests medical examinations using the Form SSA e2960 IS-USA 3 (Iceland – U.S. Agreement on Social Security Transmittal/Request/Certification Form).

Medical evidence is evidence that SSA obtained in connection with a continuing disability review or a disability claim filed or adjudicated within a year of the date for which the Icelandic Liaison Agency has specifically requested medical evidence. SSA schedules an examination, or forwards “pertinent medical evidence” from SSA files to the Icelandic Liaison Agency. SSA's files include paper claims folders and electronic files.

SSA requests reimbursement for the cost of medical examinations obtained for the Icelandic Liaison Agency using Form SSA 1278 U.S. - IS-9 (Request for Payment of Reimbursable Expenses under U.S./Iceland Agreement on Social Security). Once the form is completed, scan it into the electronic file and send a copy to:

Iceland Social Insurance Agency (SIA)

Tryggingastofnun International Hlíðasmári 11,

201 Kópavogur

Iceland

Note: You can print this form from the SSA Totalization Forms section of the Office of Earnings and International Operations, Division of International Operations Totalization Resource Kit.