TN 2 (07-86)
GN 01706.235 Handling forms IT/USA SS-3 (Medical Report) for INPS
When a U.S. resident files a claim for Italian disability benefits, INPS requires
form IT/USA SS-3. This form is a medical report that must be completed by the claimant's
doctor. We have agreed to send the form to the claimants and advise them that it is
required by INPS. However, we will not control the request.
Form IT/USA SS-3 should be sent to a claimant in the United States in the following
An application form SSA-3954-BK-IT is received in OIO from a claimant for Italian
disability benefits (including disabled auxiliaries, except wives, listed on the SSA-3954-BK-IT);
A request is received from INPS asking OIO to obtain an application form SSA-3954-BK-IT
from a disability claimant, and INPS is not requesting a medical examination.
CAs generally will send the forms in concurrent RSDI/totalization situations; BETs
generally will send them in totalization-only situations.
Refer to GN 01704.530.B for specific instructions on sending the form.