TN 2 (09-11)

NL 00720.360 TOT Totalization

TOT004 INITIAL AWARD CLAIMANT FULLY INSURED WITHOUT FOREIGN COVERAGE (F15)

(Requested)

Caption: Your Benefits

 (1)  for benefits using work covered by the U.S. only. Under our agreement with  (2)  , no U.S. benefits may be paid using work covered by  (3)  if  (4)  for benefits without it.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Beneficiary's Name qualifies

Choice 2: You qualify

Fill-in (2) - Requested As A One Position Alpha Character Name of Country (under agreement)

Choice 1: (A) Italy

Choice 2: (B) Germany

Choice 3: (C) Switzerland

Choice 4: (D) Norway

Choice 5: (E) Sweden

Choice 6: (F) Canada

Choice 7: (G) Austria

Choice 8: (H) Belgium

Choice 9: (I) United Kingdom

Choice 10: (J) Spain

Choice 11: (K) France

Choice 12: (L) Portugal

Choice 13: (M) Netherlands

Choice 14: (N) Finland

Choice 15: (O) Ireland

Choice 16: (P) Luxembourg

Choice 17: (Q) Greece

Choice 18: (R) Chile

Choice 19: (S) Korea

Choice 20: (T) Australia

Choice 21: (U) Japan

Choice 22: (V) Denmark

Choice 23: (W) The Czech Republic

Choice 24: (X) Poland

Choice 25: (Y) Slovakia

Choice 26: (Z) Hungary

Fill-in (3) - Systems Generated

Same as Fill-in (2)

Fill-in (4) - Systems Generated

Choice 1: she qualifies

Choice 2: he qualifies

Choice 3: you qualify

TOT009 TOTALIZATION BENEFITS AWARDED (F03)

(System Generated)

Caption: We considered foreign payments

 (1)  applied for benefits under the agreement between the United States and  (2)  .  (3)  for U.S. Social Security benefits based on combined credits from both countries.

Fill-in values:

Fill-in (1) – Systems Generated

Choice 1: Beneficiary's full name

Choice 2: your

Fill-in (2) – Systems Generated

Choice 1: (A) Italy

Choice 2: (B) Germany

Choice 3: (C) Switzerland

Choice 4: (D) Norway

Choice 5: (E) Sweden

Choice 6: (F) Canada

Choice 7: (G) Austria

Choice 8: (H) Belgium

Choice 9: (I) United Kingdom

Choice 10: (J) Spain

Choice 11: (K) France

Choice 12: (L) Portugal

Choice 13: (M) Netherlands

Choice 14: (N) Finland

Choice 15: (O) Ireland

Choice 16: (P) Luxembourg

Choice 17: (Q) Greece

Choice 18: (R) Chile

Choice 19: (S) Korea

Choice 20: (T) Australia

Choice 21: (U) Japan

Choice 22: (V) Denmark

Choice 23: (W) The Czech Republic

Choice 24: (X) Poland

Choice 25: (Y) Slovakia

Choice 26: (Z) Hungary

Fill-in (3) – Systems Generated

Choice 1: He qualifies

Choice 2: She qualifies

Choice 3: You qualify

TOT010 APPLICATION CLAIM FOR ANOTHER COUNTRY (F11)

(Requested/Generated)

Caption: Other Social Security Benefits

 (1)  application is also a claim for social insurance benefits from  (2)  .  (3)  will let you know if  (4)  for benefits under  (5)  laws.

Fill-in values:

Fill-in (1) - Systems Generated

Choice 1: Beneficiary name possessive

Choice 4: Your

Fill-in (2) - Requested As A One Position Alpha Character Name of Country

Choice 1: (A) Italy

Choice 2: (B) Germany

Ch