PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 017 – Totalization BenefitsSubchapter 52 – OIO and FSP Processing Under the Agreement with PolandTransmittal No. 2, 06/22/2020
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure
Summary of Changes
GN 01752.025 Zaklad Ubezpieczen Spolecznych (ZUS) Liaison Agency
Zaklad Ubezpieczen Spolecznych (ZUS) or Kasa Rolniczego Ubezpieczenia Spolecznego (KRUS) are the only Republic of Poland insurance agencies that will be used to communicate and process the agreement workload. ZUS is responsible for the Social Insurance Institution and KRUS is responsible for the Agricultural Social Insurance Institution of Poland. If periods of agriculture are alleged all applications go to KRUS for determination.
Transmit information to and/or request information from ZUS or KRUS via form SSA-e2960-U3–PL.
Use the following address and contact information for ZUS:
This office investigates claims for benefits from ZUS under the Agreement for claimants residing in Poland, in the USA or in third country.
This office is responsible for PL/USA 4 (Retirement/Disability Application), PL/USA 5 (Survivor Benefit Application), PL/USA 7 (Request for Medical Evaluation), USA/PL 6 (ICERS), PL/USA 8 (Reimbursement for Medical Evaluation Expense) or PL/USA 10 (Burial/Funeral Benefit Application).
The following forms may be printed from the SSA Division of International Operations (DIO) Totalization Forms section of the Totalization Resource Kit:
SSA-e2960–U3–PL Transmittal Request Certification Form
PL/USA4 Request for Polish retirement – Annuity for Inability to Work
PL/USA5 Request for Polish Family Pension
SSA-USA/PL6, PL/USA6 Certificate Concerning Insurance Periods in Poland
PL/USA7 Medical Evaluation
PL/USA8 Request for Reimbursement for Medical Examination Expense
PL/USA10 Request for Payment of Polish Burial Allowance