TN 2 (09-85)

GN 01704.710 Transmittal/Request Forms (SSA-2960)

A. General

 

COMPLETE THESE FORMS IN LEGIBLE BLOCK PRINTING.

 

The transmittal/request form is the cover sheet of packages prepared for foreign agencies in Italy and Switzerland. The form is printed in English and the official language(s) of the country of agreement. As the name suggests, it is a routing form used to transmit information and documents to foreign agencies. It is also used to request information from foreign agencies.

It is a snap-out form consisting of at least the original (blue) and a file copy (white). If the form is used to request information, prepare a Form SSA-382-U2 to control the request.

Enter identifying information fully and legibly. Never leave the “foreign insurance number” block blank—enter either the number or “Unknown.”

Part II and Part III of the form should be completed, if appropriate. Check the appropriate boxes and enter names and dates as needed. If the “other” block in Part II and/or Part III is used, be specific and concise. Either request information using Part III or indicate that no information is being requested.

Part IV of the form is used for “Remarks.” When making an entry in this block, be concise. Do not use jargon.

Sign and date the file copy of Form SSA-2960.

B. Form SSA-2960-U5-IT

Complete this form as above. In addition, the Italian version calls for identifying information about “the Primary Claimant if other than the worker.” These three blocks should be completed with identifying information about an individual who is filing on behalf of the worker.

Enter the name and address of the appropriate Italian office in the “To:” block, either by block printing or adhering preprinted labels. The appropriate office is:

  1. The office from whom INTPSC received the claim or a request for assistance or, if this does not apply;

  2. The regional office in the province where the worker last worked; or

  3. If the worker's only Italian work was in Italian military service, the regional office servicing the province of the military district to which the worker was assigned; or

  4. The INPS office shown on the Acknowledgment Copy of Form SSA-2960-U5-IT; or

  5. The INPS regional office in Rome, if correct regional office cannot be determined—enter “UNABLE TO DETERMINE CORRECT REGIONAL OFFICE” in remarks.

Always complete Part II, H. when the form is prepared in response to a request from an Italian agency.

NOTE: Page 5 of this form is an “Acknowledgment Copy,” which is to be completed by INPS, returned to INTPSC and prongfiled in the totalization folder. The office shown on the form is the INPS office with jurisdiction. INTPSC's technicians should correspond with that office regarding the claim.

C. Form SSA-2960-SZ

The address of the Caisse Suisse de Compensation (CSC) is preprinted on the form.

Part II is self-explanatory. Complete Part III by checking item A or at least one of the other items. If item C is checked requesting Swiss earnings and coverage information, request the information for all years beginning 1948 for new claims; for recomputations, request the information from the date of the last certification after conferring with a claims authorizer.

D. Status requests

  1. If no response is received to an initial request within the diary period, prepare status requests by preparing a new Form SSA-2960 as above, plus the following:

    1. Identify the new form by printing “Status Request” in the top left-hand margin.

    2. Enter “Photocopy of original request attached” in the “other” block of “Transmittal of Information by U.S.”

    3. Unless additional information is being forwarded, do not check any other blocks.

    4. Complete all items checked on the original request and complete the “Status of our request” block.

  2. If it is necessary to prepare a second status request, complete a new form as above. Also enter “Second Status Request—original request dated          , first request for status dated          .”

E. Diary periods

1. Italy

  1. P1 Cases—Diary initial requests to INPS for 1 year. If no response is received in a year, send the first status request and diary it for 6 months. If no response is received, send the second status request and diary it for 6 months. If still no r