COMPLETE THESE FORMS IN LEGIBLE BLOCK PRINTING.
These forms are used to transmit information about claimants from our files to foreign
agencies. Foreign agencies will accept data marked “verified” on these forms as valid and factual. Therefore, when vital statistic data are provided,
check either “verified” or “alleged” to indicate whether the data are verified by SSA records or merely alleged by the
There is no need to complete these forms if the foreign agency does not need the information.
Therefore, complete liaison forms only if you are forwarding the application for benefits
to that agency and certifiable data are available from the MBR or the RSDI claims
folder; or the foreign agency has requested the information. Do not complete the form
if the foreign agency has requested an earnings record for a claim filed with the
agency—assume, unless specifically requested, that the foreign agency has all the
vital statistics needed.
The liaison certification Form SSA-1279 concerns general and identifying information
about the worker.
The liaison Form SSA-1280 concerns general and identifying information about the spouse,
former spouse or widow(er) of the worker.
The liaison Form SSA-1281 concerns all other claimants on the worker's record.