BASIC (07-09)

GN 01752.025 Zaklad Ubezpieczen Spolecznych (ZUS) Liaison Agency

A. Policy – Role of ZUS Liaison agency

Zaklad Ubezpieczen Spolecznych (ZUS) or Kasa Rolniczego Ubezpieczenia Spolecznego (KRUS) will be the only Republic of Poland insurance agencies that will be used to communicate and process the agreement workload. ZUS is responsible for the Social Insurance Institution and KRUS is responsible for the Agricultural Social Insurance Institution of Poland. If periods of agriculture are alleged all applications go to KRUS for determination.

B. Procedure – transmit or request information from ZUS or KRUS

Transmit information to and/or request information from ZUS or KRUS via form SSA-2960-USA/PL3.

Use the following address and contact information for ZUS:

Zaklad Ubezpieczen Spolecznych (ZUS)
1 Oddzial ZUS w Warszawie
Wydzial Realizacji Umow Miedzynarodowych
Ul. Kasprowicza 151
01-949 Warszawa, Poland

Tel: 0-048-22-569-36-04
Tel: 0-048-22-569-36-74
Tel: 0-048-22-827-36-46
Fax: 0-048-22-827-53-71

This office investigates claims for benefits from ZUS under the Agreement for claimants residing in Poland, in the USA or in third country.

This office is responsible for PL/USA 4 (Retirement/Disability Application), PL/USA 5 (Survivor Benefit Application), PL/USA 7 (Request for Medical Evaluation), USA/PL 6 (ICERS), PL/USA 8 (Reimbursement for Medical Evaluation Expense) or PL/USA 10 (Burial/Funeral Benefit Application).

C. The role of ZUS under the Polish agreement

This office investigates claims for benefits from ZUS under the Agreement for claimants residing in Poland, in the USA or in third country.

This office is responsible for PL/USA 4 (Retirement/Disability Application), PL/USA 5 (Survivor Benefit Application), PL/USA 7 (Request for Medical Evaluation), USA/PL 6 (ICERS), PL/USA 8 (Reimbursement for Medical Evaluation Expense) or PL/USA 10 (Burial/Funeral Benefit Application).

D. Exhibits of Polish Totalization Forms

The following forms may be printed from the SSA Totalization Forms section of the Totalization Resource Kit on the Office of International Operations (OIO) webpage: http://ocoweb.ba.ssa.gov/oio/SSA%20Tot%20Forms/ssaTotForms.asp

SSA-USA/PL3, PL/USA3, Transmittal Request Certification Form

PL/USA4, Request for Polish retirement – Annuity for Inability to Work

PL/USA5, Request for Polish Family Pension

SSA-USA/PL6, PL/USA6, Certificate Concerning Insurance Periods in Poland

PL/USA7 – Medical Evaluation

PL/USA8, Request for Reimbursement for Medical Examination Expense

PL/USA10, Request for Payment of Polish Burial Allowance


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201752025
GN 01752.025 - Zaklad Ubezpieczen Spolecznych (ZUS) Liaison Agency - 07/16/2009
Batch run: 07/16/2009
Rev:07/16/2009