Effective Dates: 05/02/2017 - Present Previous | Next

Basic (07-09)

GN 01752.205 Preparing Claims Packages in DIO for Claims Filed Outside of the Republic of Poland

A. Procedure – Initial Claims Packages to request Polish certified coverage records

Prepare initial claims packages to request Polish certified coverage records and to inform ZUS or KRUS about claims for Polish benefits.

Refer to GN 01752.025 – GN 01752.030

B. Procedure – U.S. Claims Form SSA-e2960–U3–PL

Prepare form SSA-e2960–U3-PL and forward it to ZUS or KRUS if the Polish record is not in the claims file.

C. Procedure – Claims packages for U.S. Claims/Republic of Poland Totalization Benefits

Prepare a claims package that includes:

  • •

    Form SSA-e2960–U3–PL to request a Polish certified coverage record (PL/USA 6) if needed and to certify the filing date for Polish benefits, establish factors of entitlement, and U.S. benefit information.

  • •

    A U.S. totalization earnings record.

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    Medical evidence from SSA’s files, if the Polish claim is for disability benefits. In addition, if a completed physician’s medical evaluation report (PL/USA 7) is not included, follow up with the claimant 7 days after receipt of application. Tickle for 53 days and mail package if not received when tickle is due.

  • •

    Any necessary proofs and evidence.

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    Letter to claimant advising them that their claim was forwarded to the ZUS /KRUS Agency if claim is for Polish benefits only.

D. Reference

GN 01751.150 – GN 01751.225, Application and Evidence for Polish Agreement

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201752205
GN 01752.205 - Preparing Claims Packages in DIO for Claims Filed Outside of the Republic of Poland - 05/02/2017
Batch run: 10/15/2018
Rev:05/02/2017