BASIC (01-94)

GN 01722.105 Spanish Coverage Certification

A. Introduction

Spanish coverage is certified on the bilingual form E/USA 4. Coverage is certified up to the worker's disability onset, retirement or death. There is no lag period.

Coverage certifications are issued by the office with jurisdiction, either the ISM or the INSS provincial office. Coverage certifications sent to OIO by any of the Spanish liaison agency offices will contain a complete record of an individual's work in Spain.

B. Description of form E/USA 4

The following is a description of the items on the form:

1. Identifying Information

The top of the form contains the necessary information (Social Security number, name and date of birth) to identify the worker.

2. Periods of Coverage

  • The first two columns show the “FROM - TO” dates of each continuous period of coverage. The dates are shown in day/month/year format.

  • The total number of days for each period of coverage is shown in the third column.

  • The remark “R00-1080” in the “FROM-TO” column indicates there is coverage for the years 1937 - 1939. The Spanish agencies cannot identify specific days of coverage for these years. If the remark is shown, Spain enters 1080 days of coverage in the third column.

3. Spanish Agency Certification

The bottom of the form contains the stamp of the agency that issued the coverage certification, signature of the authorizing individual and the date.

C. Exhibit E/USA-4



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GN 01722.105 - Spanish Coverage Certification - 04/02/2014
Batch run: 04/02/2014