TN 1 (04-19)
If the Brazilian liaison agency, the National Social Insurance Institute (INSS) requests
a medical examination for a U.S. resident, the Social Security Administration (SSA)
will schedule the examination and send the results to INSS.
To obtain medical examinations for INSS, use the following process:
INSS requests medical examinations using the Form SSA 2960 USA/BR 3 (U.S. Brazil Agreement
on the Social Security Transmittal/Request/Certification).
Pertinent medical evidence is medical evidence that SSA obtained in connection with
a continuing disability review or a disability claim filed or adjudicated within a
year of the date for which INSS has specifically requested medical evidence. SSA schedules
an examination, or forwards “pertinent medical evidence” from SSA files to INSS. SSA’s
files include a paper claims folder and electronic files.
SSA requests reimbursements for the cost of medical examinations obtained for INSS
using form 1278 USA/BR 9 Request for Payments of Reimbursable Expenses under U.S.
Brazil Agreement on Social Security. Once the form is completed, scan it into electronic
file and send a copy to:
NOTE: You can print this form from the SSA Totalization Forms section of the Division of
International Operation’s “Totalization Resource Kit”.