TN 1 (04-94)
GN 01716.212 Completing Liaison Agency Certification on Forms CDN/USA 1 and QUE/USA 1
An explanation of how the FO completes the liaison agency certification is given in GN 01715.225-GN 01715.230. The following instructions supplement that section and provide additional instructions for DIO.
Follow these steps when completing the liaison agency certification:
If the applicant's signature on the CDN/USA 1 is not witnessed, take no action. (Ottawa will secure a witnessed signature.)
When entering dates, write out the name of the month rather than showing the date entirely in numbers; e.g., March 2, 1990 rather than 3/2/90.
If the applicant is filing for surviving spouse benefits from Quebec, enter the date of birth of the surviving spouse below the signature line on the QUE /USA 1 as follows, “Date of birth of surviving spouse - March 2, 1990.” Initial the entry.
If the certification sections on the CDN/USA 1 or QUE/USA 1 are completed by unauthorized personnel; e.g., a CR in a non-designated FO, take the following action:
Check the entries.
If the entries are correct add your initials to the “Verified by” block on the CDN/USA 1 using a different color ink. Make no entry in the “Verified” block on the QUE/USA 1.
If an entry is incorrect, line it out, enter the correct date and add your initials to the “Verified by” block on the CDN/USA 1 using a different color ink. Place an additional “X” in the “Verified” block of the QUE/USA 1.
Enter the current date, your signature, title and DIO in the appropriate spaces on the QUE/USA 1.
Stamp the QUE/USA 1 with the DIO stamp.