BASIC (01-94)

GN 01722.035 INSS Referral Letter

A. Exhibit — Spanish version

 

  
MINISTERIO DE TRABAJO Y SEGURIDAD SOCIAL 
Secretaria General para la Seguridad Social 
Instituto Nacional de Seguridad Social 
 Social Security Administration
Office of International
Operations
P.O. Box 17049
Baltimore, MD 21235
Estados Unidos de America

 

SU REFERENCIA: ..............................

PRESTACION: .................................

SOLICITANTE: ................................

CAUSANTE: ...................................

FECHA NACIMIENTO: DD/MM/AA

No. DE AFILIACION EN ESPANA:   /  /  .

No. DE AFILIACION EN USA:   /  /  .

Acusamos recibo de la documentacion de referencia, informandose que con esta misma fecha se remite a:

 

  • DIRECCION PROVINCIAL DEL INSTITUTO
    NACIONAL DE LA SEGURIDAD SOCIAL
    DOMICILIO
    PROVINCIA

     

competente para el tramite y resolucion del correspondiente expediente y a la que deberan dirigirse en lo sucesivo para todo lo relacionado con dicha peticion.

 

EL SUBDIRECTOR GENERAL DE GESTION

 

P.D. LA JEFE DEL SERVICION DE COLABORACION

AMINISTRATIVA Y PRESTACIONES A CORTO PLAZO

B. Exhibit — English version

 

  
Department of Labor and 
Social Security 
Central Social Security Office 
 Social Security Administration
Office of International
Operations
P.O. Box 17049
Baltimore, MD 21235
United States of America

YOUR REFERENCE: ...............................

 

TYPE OF CLAIM: ................................

APPLICANT: ....................................

WAGE EARNER: ..................................

DATE OF BIRTH: DAY/MONTH/YEAR

SPANISH SOCIAL SECURITY NUMBER:   /  /  .

U.S. SOCIAL SECURITY NUMBER:   /  /  .

We acknowledge receipt of the documentation in reference and we inform you that on this same date it is being forwarded to:

 

  • PROVINCIAL OFFICE OF THE NATIONAL

    INSTITUTE OF SOCIAL SECURITY

    ADDRESS

    PROVINCE

     

competent for the development and adjudication of the corresponding claim and to which all future inquiries regarding said claim must be addressed.

THE DEPUTY GENERAL DIRECTOR FOR OPERATIONS

 

P.D. THE CHIEF OF THE DEPARTMENT OF ADMINISTRATIVE COLLABORATION AND SHORT-TERM BENEFITS


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201722035
GN 01722.035 - INSS Referral Letter - 04/01/2014
Batch run: 04/01/2014
Rev:04/01/2014