TN 6 (10-03)
GN 01715.225 Completion of Application for Canadian Benefits Under the Agreement on Social Security Between Canada and the United States (CDN-USA 1)
The CDN-USA 1 application form is available through the Intranet at http://eis.ba.ssa.gov/eis/misc/resource-kits/resourcekits.htm and is designed for self-help use. Once at this Intranet address, select "Totalization Benefits" from the listing and on the next webpage select "Totalization Forms". A guide is also available through the Intranet that includes comprehensive instructions on how to complete the form.
B. Procedure - General
1. Completing form CDN-USA 1
Most individuals filing for Old-Age Security (OAS) and Canada Pension Plan (CPP) benefits should be able to fill out the CDN-USA 1 without assistance using the completion instructions provided with the application. Should a claimant require assistance in completing the form, refer to the item-by-item instructions starting on page 8 of the instruction guide.
2. Verification of eligibility factors
Sections 1 and 6 of the CDN-USA 1 each contain a block headed “FOR USE BY THE SOCIAL SECURITY ADMINISTRATION ONLY.” These blocks are completed only by staff in the Office of International Operations (OIO) or one of the designated border offices identified in GN 01715.320. The blocks are used to inform the Canadian agency which, if any, of the items identified in sections 1 and 6 have been verified for SSA purposes.
C. Procedure - completing SSA blocks — OIO or designated border offices only
1. Date of Receipt
Always complete the “DATE OF RECEIPT” to show the date claim filed. Enter the date the CDN-USA 1 is filed in the field office (FO) or, if applicable, an earlier protective filing date.
2. Verified By
Enter your initial in the “VERIFIED BY:” space.
3. Other Items
Make entries next to the dates in Sections 1 and 6 only if SSA has established the relevant date in connection with a concurrent retirement, survivors or disability claim, or the date was previously established in connection with a prior claim and the date is available from the master beneficiary record (MBR). When an alleged date has been proven for SSA purposes, check the box beside “AS STATED.” If SSA has established a date different than the one alleged by the claimant, check the box next to the blank line and enter the proven date on the line. The proper date should be entered in year, month, and day order. (EXAMPLE: if the date of birth is January 2, 1935, enter 1935/Jan/02.) If SSA has not established an alleged date, make no entry by that date. If any entries are made next to the dates in Section 6, enter your initials in the “VERIFIED BY:” space.
Note: When a designated border office or OIO indicates in Section 1 or 6 that a particular factor has been established for SSA purposes, it is not necessary to send to the Canadian agency photocopies of evidence used to establish that factor.