TN 1 (04-94)

GN 01716.212 Completing Liaison Agency Certification on Forms CDN/USA 1 and QUE/USA 1

A. Introduction

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.

B. Procedure

Follow these steps when completing the liaison agency certification:

 

STEPACTION

1

If the applicant's signature on the CDN/USA 1 is not witnessed, take no action. (Ottawa will secure a witnessed signature.)

2

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.

3

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.

4

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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201716212
GN 01716.212 - Completing Liaison Agency Certification on Forms CDN/USA 1 and QUE/USA 1 - 06/12/2017
Batch run: 06/12/2017