Claims packages are prepared to request Luxembourg coverage records and to inform
the Luxembourg agencies about claims for Luxembourg benefits. The application and
evidence required for the packages are described in GN 01733.205 - 01733.215.
Use these instructions for preparing claims packages.
Prepare a claims package only if a Luxembourg coverage record is needed. Include Liaison
Form SSA-2960-U3-LX in the package.
Prepare a claims package that includes:
Liaison form SSA-2960-U3-LX
U.S. totalization earnings record
Medical evidence from OIO files if the Luxembourg claim is for disability benefits
Any additional evidence that the claimant has submitted for the Luxembourg claim