GN 00904.095 Preparation of Form SSA-562-U3 - Guide for Development Clerks

A. General

It is important that enough information be given to the assisting office for an effective contact. Remember that the assisting office knows nothing about the claim except the information you give. Failure to give complete information may result in incorrect information or the return of the SSA-562-U3 for additional information.

The SSA-562-U3 is a three-part snapout carbon form. The second copy is used by the assisting DO to furnish progress reports to the requesting DO and the third copy is a control copy. On the reverse side of the top copy, there is a certification block for age, relationship or citizenship and a block for certification or Proof of Marriage. The carbons must be removed before mailing. Complete all items in the top part of the SSA-562-U3 for which you have information, whether it appears to be pertinent or not.

B. Assisting office

Type the address of the office to which you are sending the request. Be sure to include the ZIP code. (See Service Area Directory for DO Addresses.) If you cannot determine which DO is the servicing DO in multiple DO city, use the following procedure:

  1. Prepare the SSA-562-U3 with a fourth white tissue copy and send with a franked self-addressed envelope to any DO in the city.

  2. The receiving DO will route the original SSA-562-U3 to the correct servicing DO and return the copy to you showing the proper servicing DO.

C. Requesting office

Type in or stamp your return address and your unit identification (if any). Fill in the DO telephone number which the receiving office may call if any questions arise. CLAIMS ARE FREQUENTLY DELAYED BY FAILURE TO COMPLETE THIS BLOCK.

D. Request for earnings information

Give the required information (if available) as requested in the “Remarks or Reason for Request” block.

E. Rural mailing addresses

If the person to be contacted has a rural mailing address, give the telephone number and directions for locating him, if known.

F. Requests for medical evidence

Enclose an authorization for release of medical information signed by the claimant. In DAA cases, the medical release should also be signed on the reverse of the authorization form. Complete the identifying information section of the appropriate medical report form and enclose this with the SSA-562-U3. Be sure the date of onset is entered at the top of the form.

G. Requests for contact with employer on a coverage question

Enclose with the SSA-562-U3 a copy of the coverage questionnaire completed by the wage earner or surviving claimant.

H. Requests for assistance on PSC or ODO request for additional development

Enclose a copy of the PSC or ODO request with the SSA-562-U3.

I. Followup on census record requests

Either provide the applicant's name and address or enclose a photocopy of the SSA-1535-U3 or BC-600.

J. Enclosures to the SSA-562-U3

When the request is unusual or complicated, enclose copies of background material which will help the assisting DO handle the request. It is not necessary to en