Effective Dates: 05/25/2017 - Present Previous | Next

TN 1 (04-94)

GN 01716.205 Preparing Claims Packages for Claims Filed Outside Canada

A. Procedure

Prepare claims packages to request records of Canadian coverage, to request medical evidence from Quebec, and to inform the Canadian agencies about claims for Canadian benefits. If the claim originated in Canada, no claims package is necessary.

1. U.S. claim

Complete Form SSA-e2960-U3-CQ. Check item B. under “Information Needed” to request a record of Canadian coverage. Check item C. under “Information Needed” to request medical evidence from Quebec files if the claimant has filed for U.S. disability benefits. Do not request medical evidence from Ottawa.

2. U.S. and Canadian claim

Include the following information in claims packages:

  • •

    SSA-e2960-U3-CQ. Check item B. under “Information Needed” to request a record of Canadian coverage.

  • •

    CDN/USA 1 and/or QUE/USA 1 including certification of DCF and vital statistics data. (See GN 01716.212)

  • •

    U.S. coverage record

  • •

    Any additional evidence, including evidence of Canadian residence or medical evidence the claimant wants to submit.

3. Canadian claim

Include the following information in claims packages:

  • •

    SSA-e2960-U3-CQ

  • •

    CDN/USA 1 and/or QUE/USA 1 including certification of DCF and vital statistics data. (See GN 01716.212)

  • •

    U.S. coverage record

  • •

    Any additional evidence, including evidence of Canadian residence or medical evidence the claimant wants to submit.

B. Reference

Completing the USA/CDN 3, USA/QUE 3 Transmittal and Liaison Form (SSA-e2960-U3-CQ), GN 01716.220.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201716205
GN 01716.205 - Preparing Claims Packages for Claims Filed Outside Canada - 05/25/2017
Batch run: 05/25/2017
Rev:05/25/2017