BASIC (01-94)

GN 01736.235 Facts About the Irish Liaison Form IRL/USA3

A. When to use form IRL/USA 3

The Irish agency uses liaison form IRL/USA3 to:

  • transmit material to OIO or the FSP in Dublin

  • send information to OIO or the FSP, and

  • request information from OIO

B. Exhibit

G-GN_01736.235B

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C. Description of form IRL/USA 3

  • Part 1 contains general information and includes space for the Irish agency to list the information needed for OIO to locate an unknown SSN. It also provides check blocks for the Irish agency to indicate the type of claim for U.S. and/or Irish benefits.

  • Part 2 contains spaces for the Irish agency to indicate claimants' names, dates of birth and other information and to indicate whether those dates have been verified by acceptable evidence.

  • Part 3 contains information from the Irish agency that indicates evidence is attached or that it will follow.

  • Part 4 contains a list of the types of information that the Irish agency might request from OIO along with the remark that the information is needed to process a claim under the agreement.

  • Part 5 contains space for the Irish agency to indicate to OIO the date that it forwarded a claim for U.S. benefits to the FSP in Dublin.

D. Procedure

In addition to the procedures for handling foreign agency liaison forms contained in GN 01704.000ff, the following applies:

  • In OIO, treat any indication under the “U.S. Benefits” column in part 1.D. as a claims lead for U.S. benefits unless the Irish agency indicated in Part 5 that the claim was transferred to the Dublin FSP.

  • return to the Irish agency, via form SSA-2960-U3-IR, any request that does not indicate that it is needed to process a claim under the agreement, unless written consent to disclosure is attached, or there is an SSA-2490 in file, signed by the claimant.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201736235
GN 01736.235 - Facts About the Irish Liaison Form IRL/USA3 - 04/22/2014
Batch run: 04/22/2014
Rev:04/22/2014