Claims packages are prepared to request French coverage and medical evidence and to
inform the Center for Social Security for Migrant Workers about claims for French
Include the following information in claims packages:
SSA-e2960-U3-FR (check item VI—coverage record to request a French coverage record).
A work history statement if the worker is not a French beneficiary.
U.S. Earnings Record.
Parts I and II of the Disability Annex (USA/FR 3a) if the French claim is for disability
Medical evidence from the DIO file if the French claim is for disability benefits.
Medical Report Form (SE 404-4) if there is no pertinent evidence in DIO file to be
included in the package.
Medical Report From (SE 404-4) if there is no pertinent medical evidence in DIO files
to be included in the package.
Evidence Required for U.S. Totalization Benefits, GN 01723.205
Developing Evidence in Claims for French Benefits, GN 01723.210