TN 1 (04-94)

GN 01716.005 How the Division of International Operations (DIO) Modules Review and Complete Claims Taken by a Field Office (FO) or Canadian Agency

A. Process

The FO stocks applications required by the agreement/understanding, including the special applications required for Ottawa and Quebec. All claims for U.S. benefits filed under the Canadian Agreement/Quebec Understanding, with the rare exception of claims filed in a third country, should arrive in DIO fully developed. Furthermore, claims filed in Canada should contain a copy of the Canadian coverage record and be ready for adjudication of the totalization claim. This is because all claims originating in Canada are sent, along with a copy of the Canadian coverage record, directly to the servicing border office for complete development of the U.S. claim and an initial insured status denial. Furthermore, when claims originate in a designated border office, that office requests that a copy of the Canadian coverage record be sent to DIO, as well as fully developing all claims and adjudicating the initial insured status denial.

B. Procedure — claims origin

1. Claim originated in designated border FO

(See list of designated border FOs in GN 01715.320)

  1. Ensure the U.S. totalization claims file contains:

    • U.S. national application(s)

    • SSA-2490-F4

    • All required evidence

      NOTE: If any of the above is missing, request it from the FO.

    • U.S. earnings record (if missing, request from DEBS)

    • Copy of SSA-e2960-U3-CQrequesting Canadian coverage record (if missing, request from Canada Pension Plan (CPP) or Quebec Pension Plan (QPP))

    • 026 denial (if missing, include with totalization decision if Canadian coverage record in file)

  2. Ensure the Canadian claims file contains an SSA-e2960-U3-CQshowing that any claims for QPP, CPP, or Old Age Security (OAS) benefits were sent to the correct agency. If missing, prepare claim(s) package(s) for Ottawa/Quebec.

2. Claim originated in non-border FO

  1. Be sure the U.S. totalization claims file contains:

    • U.S. national application(s)

    • SSA-2490-F4

    • All required evidence

      NOTE: If any of the above is missing, request it from the FO.

    • U.S. earnings record (if missing, request from DEBS)

    • 026 denial (if missing, process in DIO while awaiting Canadian coverage record)

  2. Be sure the Canadian claims file contains:

    • CDN/USA 1 and/or QUE/USA 1

    • SSA-2490-F4

      NOTE: If any of the above is missing, request it from the FO.

    • U.S. earnings record (if missing, request it from DEBS)

    • Medical evidence

    • Residence evidence

      NOTE: If no medical evidence or residence evidence submitted, do not request.

    Send claims package and if necessary request Canadian coverage record (see GN 01716.205 on Preparing Claims Packages).

3. Claim originated in Quebec/Ottawa

  1. Be sure the U.S. totalization claims file contains:

    • U.S. national application(s)

    • All required evidence

      NOTE: If any of the above is missing, request it from the FO.

    • U.S. earnings record (if missing, request it from DEBS)

    • SSA-1294-F6-CN, if claim originated in Ottawa (do not request from CPP unless CPP did not certify a filing date)

    • Canadian coverage record (request from CPP or QPP)

    • 026 denial (include with totalization decision if Canadian coverage record in file)

  2. Ensure the Canadian claims file contains an CDN/USA 2 or QUE/USA 2 requesting a U.S. earnings record or other information. If missing, assume Canada needs no information from SSA.

    If information is requested, obtain the requested information and prepare a claims package. See GN 01716.210 on preparing claims packages.

C. Procedure — DAESS

For claims originating in Quebec, DIO and the Direction de l'Administration des ententes de securite sociale (DAESS) have agreed to the following:

 

IF THEN
  • the claimant does not choose the earliest possible MOE

 

include the claimant's explanation for choosing a later month