Basic (03-25)

GN 01764.325 Social Security Administration (SSA) Medical Exam Reimbursement Form

SSA uses the Form SSA 1278 U.S.- IS 9 (Request for Payment of Reimbursable Expenses under U.S.A.–Iceland Agreement on Social Security) for reimbursement of medical expenses regarding requests for exams.

The Form SSA 1278 U.S.- IS 9 (Request for Payment of Reimbursable Expenses under U.S.A. – Iceland Agreement on Social Security) is available on the SSA Totalization Forms section of the Office of Earnings and International Operations, Division of International Operations, Totalization Resource Kit.

Mail the form to:

For Disability Claims:

Social Insurance Administration

Tryggingastofnun International

Hlíðasmári 11,

201 Kópavogur

Iceland