Effective Dates: 03/08/2017 - Present Previous | Next

TN 1 (02-95)

GN 01724.235 Facts About the French Liaison Form SE 404-03

A. When to use form SE 404-03

France uses Form SE 404-03 to:

  • •

    transmit claims and related material to DIO.

  • •

    send information requested by DIO to us, and

  • •

    request information from DIO.

B. Description of the SE 404-03

Form SE 404-03 is identical to the SSA-e2960 U3-FR in the order of the information blocks and the wording of each block. However, the layout of the blocks differ. The SE 404-03 is bilingual and printed on more than one page.

C. Exhibit — SE 404-03

The following is an exhibit of Page 1 of the SE 404-03 (USA/France Liaison Form).

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201724235
GN 01724.235 - Facts About the French Liaison Form SE 404-03 - 03/08/2017
Batch run: 03/08/2017
Rev:03/08/2017