Basic (04-20)

GN 01762.325 Social Security Administration (SSA) Medical Exam Reimbursement Form

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

Banco de Prevision Social
Colonia 1881 Piso 2
C.P. 11200
Montevideo, Uruguay