TN 11 (06-97)

GN 00904.240 Use of the form SSA-1320-U4 in OIO

A. Introduction

Generally, the SSA-1320-U4 is used to request the assistance of FSPs not trained in claims taking.

B. Procedure — completion of the form

Complete the SSA-1320-U4 as follows:

 

 Item:Completion:
Refer toShow the name of your component (e.g., CDS-1).
Address of FSPShow the FSP address. (See NL 01510.000 ff. to identify the FSP in countries which have more than one FSP.)
Social Security NumberEnter the NH's SSN and the claim's symbol for the individual(s) whose case is being developed.
DateEnter the day's date plus three days.
Worker's NameSelf-explanatory
Beneficiary or Claimant's NameShow the name of the individual about whom development is being requested.
Name and Address of Foreign ContactShow the name or title of the individual or institution to be contacted.
 Provide complete address information.
 Show the phone number of the individual or institution to be contacted, if this is in the file.
 If more than one individual or institution is to be contacted, show the principal contact in this space and names and address of all other contacts in “Remarks.”
 If the contact is not the claimant or beneficiary but resides in the same country, include the address of the claimant or beneficiary in “Remarks” so that the FSP can contact him/her if more information is needed.

Preprinted Development Functions

  • Determination of Representative Payee

This block refers FSPs which do not take claims to guides for representative payee development.

Show specific instructions under “Remarks.”

  • Completion of Forms

List the forms to be completed by the foreign contact(s). Attach the forms if the request is not to a claims-taking FSP.

Complete any items possible; such as, the SSN, NH's name, name of school, if school development is needed, etc.

  • Other Actions

Check this block when development instructions are provided under “Remarks.”

Remarks

State the request simply and concisely.

Include all pertinent information, including the name and address of the inquirer if it is other than that shown in the "Contact” block.

Do not use technical terms, abbreviations or claims symbols.

Show POMS references if the request is to a claims-taking FSP. For all other FSPs do not use these references. References to the Foreign Affairs Manual and the Social Security Handbook can be used.

Refer to previous correspondence if there has been any with the FSP on the case. Send copies of completed applications, proofs, statements or other evidence in file only if they are pertinent to the issue under development.

Enclosures

Show the number of enclosures.

C. Procedure — release of the form

Release the first and second copies of the form. Staple any attachments to these copies.

File the third and fourth copies in the claims folder.


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