TN 3 (03-97)
The SSA-1281-U2-GE is completed only by DIO. It is used to respond to German agencies'
for certification of data pertaining to children's claims, and
for information concerning the decisions made on children's claims for U.S. benefits.
The SSA-1281-U2-GE should not be included routinely in initial claims packages. It
is intended only to be used to respond to requests for assistance.
The form consists of two pages:
Page 1 (White copy) is printed in English and is for folder documentation.
Page 2 (Yellow copy) is printed in German and is the copy used to respond to a German
Follow the procedure below for completing the SSA-1281-U2-GE. MAKE ALL ENTRIES IN
LEGIBLE BLOCK PRINTING WITH A BALLPOINT PEN.
Always enter the U.S. Social Security number, the German insurance number and, if
the BFA has provided it on their request, the BFA reference number.
Item A - Enter the first and last name of each child for whom the German agency requested
Item B - Enter the date of birth for each child listed and if the MBR shows that the
child is/was a U.S. beneficiary check the “verified” block.
Item C - Enter each child's relationship to the worker (natural child, stepchild,
adopted child, etc.) as indicated on award form SSA-101-U3 or SSA-2417 and check the
“verified” block. If the RSDI folder is not available but the MBR shows that the child is/was
entitled to U.S. benefits enter only the word “child” and check the “verified” block.
Item D - If the child's application is available, enter the alleged citizenship or
check the stateless or refugee blocks as appropriate. Do not check the “verified” block.
Item E - For each child listed, enter the country of residence.
Item A - Repeat the first and last name of each child listed in I.A. in the same order.
Item B - Enter the month and year the child first became entitled to monthly benefits
after November 30, 1979. Enter “none” if entitlement never existed or “Prior to November 1979” if that is the case.
Item C - For each entitled child check one or more blocks to indicate the basis for
Item D - Leave this item blank.
Item E - For any listed child whose monthly benefits have been terminated, enter the
month and year for which the child was last entitled; i.e., the month prior to the
Item F - Check the “claim denied” block for any listed child whose claim was disallowed.
Item G - If either the child's regular or totalization claim is pending enter the
month and year six months from the current date.
Transmit the SSA-1281-U2-GE to the requesting German agency under cover of a form
SSA-e2960-U3-GE (see GN 01708.220).