TN 7 (06-04)
GN 01715.220 Application Forms for Canadian Benefits
The CDN-USA 1 (Application for Canadian Benefits Under the Agreement on Social Security Between Canada and the United States) and the QUE/USA-1 (Application for Quebec Pension Plan Benefits Under the Quebec – United States of America Social Security Understanding) are the application forms used to take claims for Canadian benefits (regular or Totalization) from persons filing in SSA field offices (FOs). Both the CDN-USA 1 and the QUE/USA-1 are available through the Totalization Benefits Resource Kit on the Intranet here. Once at this Intranet address, select "Totalization Benefits" from the listing and on the next webpage select "Totalization Forms". This section explains how to obtain the forms and instructions and when to use each form. Sections GN 01715.225 – GN 01715.230 explain how to complete the application forms.
Under Canada’s two-tier Social Security system, a person may receive an Old-Age Security (OAS) benefit plus a Canada Pension Plan (CPP) or Quebec Pension Plan (QPP) benefit. (It is not possible to receive both CPP and QPP.) The CDN-USA 1 is used if the applicant is filing for OAS and/or CPP benefits. The QUE/USA-1 is used if the applicant is filing for QPP benefits.
The worker’s last place of residence in Canada determines whether the CPP or QPP applies. Applicants should apply for QPP benefits using the QUE/USA-1 when the worker’s last place of residence in Canada was Quebec. Applicants should apply for CPP benefits using the CDN-USA 1 when the worker last resided in any other part of Canada. If the applicant is filing for both OAS and CPP benefits, only one application Form CDN-USA 1 is used.
C. Procedure – Required application(s) for Canadian benefits
The Canadian application forms are taken in the FO's. If an applicant wishes to file for Canadian benefits, the FO should:
Access the Totalization Benefits Resource Kit on the Intranet here. Once at this Intranet address, select "Totalization Benefits" from the listing and on the next webpage select "Totalization Forms".
If the applicant is filing for OAS and/or CPP benefits, print Form CDN-USA 1 and the “Guide for Completing Application” (instructions) and give them to the applicant to complete the CDN-USA 1.
If the applicant is filing for QPP benefits, print Form QUE/USA-1 and give it to the applicant for completion.
Provide any necessary assistance in completing the Canadian forms.
NOTE: Most individuals filing for Canadian benefits should be able to complete the Canadian forms without assistance using the instructions provided with the application.
Photocopy and certify any documents (evidence) submitted by the applicant.
Forward the completed claim (with certified copies of evidence) to the Office of Earnings and International Operations (OEIO)/Division of International Operations (DIO) in Baltimore at the following address: Social Security Administration
P.O. Box 17769
Baltimore, Maryland 21235-7769
Complete the Modernized Development Worksheet (MDW) screen to show the date the claim was forwarded to OEIO/DIO. Show “Totalization” as the ISSUE when completing the MDW screen.
Once OEIO/DIO receives the claim, OEIO/DIO will send the claim directly to the Canadian agency along with a copy of the applicant's U.S. coverage record, if necessary.
Forwarding applications for foreign benefits to the OEIO/DIO, GN 01702.320