When the NH meets insured status requirements based on U.S. QCs alone and Totalization could not establish an earlier month of entitlement, Totalization benefits are not payable. In this case, develop and route the claim in accordance with normal procedures. If Totalization could establish an earlier month of entitlement, route the claims folder to the Office of International Operations (OIO) at the address in GN 01702.310C. after adjudication of the claim. OIO will obtain the foreign coverage record and establish an earlier month of entitlement, if applicable.

When the NH has fewer than 6 QCs, entitlement to Totalization benefits is not possible since the NH must have at least 6 QCs before foreign coverage can be considered (see GN 01701.110). If the applicant insists on filing, take the following actions:

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  Take the appropriate application(s) but do not develop medical evidence.

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  Process the insured status denial.

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  Retain the claims folder in the field office (FO).

When the NH has at least 6 QCs but, in the judgment of the FO, would not be insured even when the alleged foreign coverage is considered, take the following actions:

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  Take the appropriate application(s) but do not develop medical evidence.

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  Process an initial insured status denial (see GN 01702.315).

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  Forward the claims folder to OIO at the address in GN 01702.310C.

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  Complete the Modernized Development Worksheet (MDW) screen to show the date the claim was forwarded to OIO. Show “Totalizatio” as the ISSUE when completing the MDW screen.

Upon receipt of the claims folder, OIO will request the foreign coverage record. If, after receiving the foreign coverage record, the NH is insured, OIO will initiate medical development. If, after receiving the foreign coverage record, the NH is still not insured, OIO will send a final insured status denial.

When the NH has at least 6 QCs but not enough to be insured and, in the judgment of the FO, would be insured when the foreign coverage is considered, take the following actions:

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  Take the appropriate application(s).

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  Process an initial insured status denial (see GN 01702.315).

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  If the applicant is:

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    an SSI beneficiary, photocopy the medical evidence and disability determination. If the folder is in another FO, request copies of the medical evidence and determination from the FO housing the folder. Forward the claims folder to OIO at the address in GN 01702.310C.

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    also applying for SSI, send the SSI disability material to the DDS for a disability determination. Upon receipt of the determination, photocopy it and the medical evidence and forward the photocopies with the title II claim to OIO at the address in GN 01702.310C.

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    not an SSI beneficiary and is not applying for SSI, send the disability material to the DDS to develop medical evidence with the notation, “Totalization Claim—No Determination Necessary—See DI 23550.001.”

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  Upon receipt of the medical evidence, forward the claims folder to OIO at the address in GN 01702.310C.

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  Complete the MDW screen to show the date the claim was forwarded to OIO. Show “Totalizatio” as the ISSUE when completing the MDW screen.