TN 2 (07-86)

GN 01706.310 Italian Liaison Form (IT/USA 3)

The IT/USA 3 may accompany the application form (IT/USA 1) when it is sent by INPS to DIO or the FSP. INPS completes the first part of this form when the totalization claim is filed in Italy. It contains identifying information about the claimant, the Italian coverage certification and information concerning the entitlement or nonentitlement of all claimants to Italian national benefits.

NOTE: The IT/USA 3 bis is acceptable without the IT/USA 3.

The second part of this form is completed by the BET. The U.S. earnings record showing QCs from 1937 to the present is attached and the information concerning each claimant's entitlement or nonentitlement to U.S. benefits is provided. Benefit amounts should be shown for the first month of entitlement only. The IT/USA 3 is then returned to INPS and a copy is retained in the file.

The third part of the IT/USA 3 is completed by INPS and returned to the United States only if the claimant is denied or if Italy pays a totalization (pro rata) benefit. The United States has advised INPS that it is not necessary to return the third part of the IT/USA 3. If the form is returned, it should be prong-filed.