Effective Dates: 10/19/2023 - Present Previous | Next

Basic (10-23)

GN 01772.320 Icelandic Medical Exam Reimbursement Form

The Icelandic Liaison Agency will use the SSA 2960 IS-USA 3 (U.S.A. – Iceland Agreement on Social Security Transmittal/Request/Certification Form) for reimbursement of medical expenses regarding requests for exams, and will attach a detailed statement of expenses incurred as a result of the medical examination.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201772320
GN 01772.320 - Icelandic Medical Exam Reimbursement Form - 10/19/2023
Batch run: 10/19/2023
Rev:10/19/2023