TN 2 (12-13)

GN 01738.220 Completing the U.S./Greece Agreement Social Security Transmittal/ Request/Certification Form (SSA-2960-USA-GR3)

A. Policy for completing the U.S./Greece Agreement

Technicians in the Office of International Operations (OIO) and personnel in the American Embassy in Athens communicate with the Greek agencies via Form SSA-2960-USA-GR3. Greek agencies’ personnel use a similar form to communicate with SSA.

B. When to use the Form SSA-2960-USA-GR3

Personnel in the American Embassy in Athens and the totalization modules in OIO complete the SSA-2960-USA-GR3. We use the form to:

  • transmit claims and related material to the Greek agencies,

  • request information from the Greek agencies, and

  • send information requested by the Greek agencies.

NOTE: Only OIO completes the blocks for verifying dates.

C. Description of the Form SSA-2960-USA-GR3

The SSA-2960-USA-GR3 is an electronic form generated from the Totalization Data Collection Program if needed.

D. Procedure for completing the Form SSA-2960-USA-GR3

Use the procedure in the following chart to complete the items on Form SSA-2960 USA/GR3.

Field

Action

Date of Original field

Current date will automatically propagate.

Date(s) of Follow-ups field

Follow-up date(s) will automatically propagate.

To field

Select the appropriate foreign agency.

From field

Office/Office Code and Fax numbers (if provided) automatically propagate based on user’s profile.

1. Part I Completing information about the claim on the SSA-2960-USA-GR3

Complete the following information about the claim on the SSA-2960-USA-GR3:

  1. Complete this section in its entirety if you are sending an initial claim to Greece.

  2. Complete only items A, B, F, and I if you are responding to a request from Greece and using this form as a transmitting document.

  3. If the claimant submits original documents, such as insurance workbooks, in support of his or her claim, prepare certified photocopies for the Claims Files Records Management System (CFRMS).

  4. Enter in item F the U.S. SSN. If unknown, enter “Alpha.”

  5. Enter in item E the insurance agency(ies) for whom the worker worked in Greece. If you need more space, use Part V, Remarks.

  6. Enter in item J the claimant’s maiden name.

  7. Enter in item K the address and telephone number when available.

  8. Select in item L the types of benefits claimed.

  9. Enter in item M the date claimant filed the claim.

  10. Place a check mark in item N if claim is restricted to U.S. Totalization Benefits only.

  11. Enter in the Remarks box the type of job the worker had in Greece if known.

REMINDER: Enter “unknown” in these spaces only after you ask the claimant these specific questions and he or she is unable to supply the information.

2. Part II Certification of Data

Complete the “Certification of Data” part of the SSA-2960 USA-GR3 only when transmitting a claim for Greek benefits, for specific information in response to the Greek agencies.

If the requested information is not available, indicate “unknown.” If you know the requested information, but our records cannot verify the information, enter the information, and do not check the “Verified” block.

Place a “?” in the verified block(s) if SSA used the data to adjudicate claims.

NOTE: Only OIO verifies these blocks.

a. Date of birth and name

  • Enter the names of all claimants and in survivor cases, the name of the deceased worker. Enter the first and last names; and

  • Enter the date of birth for all claimants and for the deceased worker, if applicable.

b. Number holder’s date of death

Enter the deceased worker’s date of death in survivor claims. Check the “Verified” block if we used the date of death to award U.S. benefits, or the MBR has a proof code for the date of death.

c. Date of marriage

Enter the date of marriage if a spouse or widow(er) claims benefits. Check the “Verified” block if we used the date of marriage to award U.S. benefits or the MBR has a proof code for the date of marriage.

d. Date of divorce

Enter the date of divorce if a divorced spouse or widow(er) claims benefits. Check the “Verified” block if we used the date of divorce to award U.S. benefits or the MBR has a proof code for the date of the divorce.

e. Work ending date

Enter the number holder’s work ending date.

f. Place of birth

Enter the number holder’s place of birth.

g. Citizenship

Enter the country of citizenship of the worker. Check the “Verified” block if we used the data to award U.S. benefits or the MBR has a proof code for the worker’s citizenship.

3. Part III Certification of Benefit Data

Complete the appropriate sections to inform the Greek agencies of the following:

  • claimants for Greek benefits;

  • responses to requests for information from the Greek agencies;

  • total U.S. Social Security benefits (before deductions) sent to Greek residents, beginning with the month of entitlement or the date of the agreement, whichever is later;

  • U.S. period of disability - Enter the month and year of the beginning and ending date of any established U.S. period of disability, whenever you are transmitting a claim for Greek disability benefits. If no period of disability has been established to determine the proper beginning and ending dates, see GN 01738.315; and

  • spouse's total benefit amount before deductions (MBC). In Part III enter “RET” or “DIB” if the spouse is receiving benefits on his or her own social security number. If the spouse is receiving benefits as a spouse, enter the following remark in Part VI, Remarks: “Receiving benefits as a spouse (also)”

    NOTE: Include the word “also” if dual entitlement exists and show each rate separately in Part III.

Place a “?” in the verified block(s) if SSA used the data to adjudicate claims.

NOTE: Only OIO completes these blocks.

4. Part IV Information Provided

Always check at least one of the blocks in this section in the following situations:

  1. Coverage Record - if you are attaching a U.S. coverage record.

  2. Medical File - if you are attaching medical evidence that the claimant submits or copies of medical evidence from SSA's files.

  3. Information Requested On - if you are giving the status of a request for information from Greece. Enter the date of their request.

  4. Other (See Remarks) - if you are attaching material, other than a claim, not covered by any block shown above.

  5. Work History/Work Books – if the claimant submitted a work history statement or workbook.

5. Part V. Information Needed

Always check at least one of the blocks in this section in the following situations:

  1. Coverage record - if you are requesting a Greek coverage record.

  2. Medical evidence - if you are requesting a copy of medical evidence contained in the Greek file.

  3. Status of Request Dated - if you want to know the status of an earlier request. Show the date of the request and attach a copy.

  4. Other (See Remarks) - if you are requesting information not covered by a block shown above. Briefly explain your request.

  5. No Information Needed – if OIO or the FSP does not need any information.

6. Part VI. Remarks

Enter clarifying or additional information using concise words, and do not use jargon.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201738220
GN 01738.220 - Completing the U.S./Greece Agreement Social Security Transmittal/ Request/Certification Form (SSA-2960-USA-GR3) - 11/04/2016
Batch run: 11/04/2016
Rev:11/04/2016