BASIC (07-09)

GN 01752.106 How to Evaluate the Republic of Poland Certified Coverage Record

A. Introduction — Polish certified coverage record

There are some entries that must be shown on the Polish certified coverage record before it can be used to credit Polish coverage. GN 01752.106B describes the entries required for an acceptable Polish certified coverage record.

B. List of Required Entries on Form PL/USA6

The required entries are as follows:

SECTION 1. Information concerning insured person

The entire section 1.1 through 1.10 which is information concerning the insured person must be completed. The required entries are the surname, surname at birth, forenames, date of birth, place of birth, father’s forename, mother’s forename, sex, address, Polish ID number, reference number (if given) and US social security number.

SECTION 2. Information concerning the claimant

Sections 2.1 through 2.10 must be completed. The required entries are claimant’s surname, claimant’s surname at birth, claimant’s forenames, claimant’s date of birth, claimant’s place of birth, claimant’s father’s forename, claimant’s mother’s forename, claimant’s sex, claimant’s address, claimant’s Polish ID number, claimant’s reference number (if available) and claimant’s US social security number.

SECTION 3. Confirmation of insured person’s insurance period in Poland (concerning person from Section 1 only)

This section must show the contributory and any non-contributory periods of employment.

Column 1 indicates the start date using year/month/day.

Column 2 indicates the stop date using year/month/day.

Column 3 is for the number of months of contributory periods listed in column 1 and 2.

Column 4 is for the number of days of contributory periods listed in column 1 and 2.

Column 5 is for the number months of non-contributory periods listed in column 1 and 2.

Column 6 is for the number of days of non-contributory periods listed in column 1 and 2.

3.1 Contributory and non-contributory periods taken into account for the acquisition of entitlement of benefits.

This entry requires months and days for contributory and non-contributory periods for acquisition of entitlement of benefits.

3.2 Contributory and non-contributory periods taken into account for the calculation of benefits.

This entry requires months and days for contributory and non-contributory periods for calculation of benefits.

SECTION 4. STAMP, DATE AND SIGNATURE

Polish stamp, date and signature are required entries.

If any of the required information is missing, contact your Office of International Operations (OIO) Division Program Analyst.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201752106
GN 01752.106 - How to Evaluate the Republic of Poland Certified Coverage Record - 07/16/2009
Batch run: 07/16/2009
Rev:07/16/2009