TN 1 (04-19)

GN 01758.325 Social Security Administration (SSA) Medical Exam Reimbursement Form

SSA uses the Form SSA 1278 USA/BR 9 (Request for Payments of Reimbursable Expenses under U.S. Brazil Agreement on Social Security) for reimbursement of medical expenses regarding requests for exams. The Form SSA 1278 USA/BR 9 (Request for Payments of Reimbursable Expenses under U.S. Brazil Agreement on Social Security) is located on the Division of International Operations website.

Mail the form to:

Address:

Social Security Agency Attendance of International Agreement
Avenue: Amazonas nº 266
9º floor, 901 room Center Belo Horizonte
Minas Gerais --CEP: 30180-001
Brazil