TN 2 (09-85)

GN 01704.555 Obtaining Evidence from District Offices (DOs)

A. General

If the source of the required documentation is in the United States and direct contact does not apply (see GN 01070.100), request the assistance of the appropriate DO by completing a Form SSA-4766-U3 as follows.

Determine which office(s) is (are) in a position to be most responsive to the request, considering the residence of the claimant and the location of the source of the record.

B. Completing the Items on the Form SSA-4766-U3

  1. 1. 

    Number Holder—Always enter the last name, first name and middle initial of the number holder.

  2. 2. 

    Claim Number—Enter the NH's SSN and the claim symbol for the beneficiary to whom the SSA-4766-U3 refers. Show “Alpha” when appropriate.

  3. 3. 

    Date—Enter the current date.

  4. 4. 

    Module—Enter module number.

  5. 5. 

    To—Enter appropriate servicing DO. This can usually be determined by the claimant's address, the DO code on the application or other material in folder, the Service Area Directory or the State and County Code Book.

  6. 6. 

    DO Code—Enter code for DO indicated.

  7. 7. 

    Furnish Status Report on Request Dated—Complete only on followup requests.

  8. 8. 

    Diary—Prepare a Form SSA-382-U2.

  9. 9. 

    From—Always circle “INTPSC.”

  10. 10. 

    TOE Code—Enter the appropriate TOE; 190 for concurrent RSDI and totalization claims; 320 for totalization claims from RSDI beneficiaries; and 430 for foreign totalization benefits only. (See GN 01704.580 for additional TOE codes.)

  11. 11. 

    Evidence Code—Enter the appropriate code.

    1. a. 

      21 R for applications;

    2. b. 

      11 R for lag earnings;

    3. c. 

      78 R for all other.

  12. 12. 

    Award—Do not complete.

  13. 13. 

    Name of Beneficiary—Enter name(s) and address(es) of claimant(s).

  14. 14. 

    Telephone Number—Enter telephone number (including area code) of claimant(s).

  15. 15. 

    Please secure. . .—Indicate whatever evidence, proofs, application, etc. are needed.

  16. 16. 

    Remarks—Indicate “Totalization Claim Pending” when applicable, and show any other remarks which are appropriate.

  17. 17. 

    “Please return attachments” should be checked if appropriate.

  18. 18. 

    Manual References—Indicate the appropriate references. (Use only references distributed to DOs.)

  19. 19. 

    Director of Operations—Line through, sign your name and shown “liaison clerk.”

C. Dispatch and Diarying

  1. 1. 

    Dispatch the original copy with any attachments in the appropriate bin.

  2. 2. 

    File remaining copies on right side of folder.

  3. 3. 

    Diary for 60 days via a Form SSA-382-U2.

  4. 4. 

    When response is received, cancel diary.

  5. 5. 

    If no response is received and diary comes due, prepare another Form SSA-4766-U3 requesting status. Attach a photocopy of original request. Diary for 60 days.

  6. 6. 

    If no response is received and diary comes due, telephone DO. Take appropriate action based on DO response.

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GN 01704.555 - Obtaining Evidence from District Offices (DOs) - 01/19/1999
Batch run: 10/17/2016