Four applications have been devised in connection with claims filed under the U.S./Canadian
Agreement/Quebec Understanding. (See GN 01715.220, GN 01715.225, GN 01715.230 and GN 01715.335.)
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1.
SSA-1294-F5-CN (USA/CAN 1, Application for Benefits Under the Canada-U.S. International
Social Security Agreement)—This application must be completed when a claim is filed
for benefits from the U.S. under the agreement /understanding unless the claim is
filed in the province of Quebec. This form is stocked in INTPSC, U.S. DOs, claims-taking
FSPs and Canadian CPP offices.
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2.
SSA-1295-F4-QU (USA/QUE 1, Understanding Between the United States of America and
Quebec on Social Security. Application for United States Benefits)—This application
must be completed when a claim is filed for benefits from the U.S. under the agreement/understanding
in the province of Quebec. This form is stocked in Quebec only.
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3.
CAN/USA 1 (Application for Canadian Benefits Under the Agreement on Social Security
Between Canada and the United States)—Persons who file with SSA for Old-Age Security
(OAS) or CPP benefits from Canada must complete this form. This form is stocked in
DOs, claims-taking FSPs and OIO.
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4.
QUE/USA 1 (Understanding Between Quebec and the United States of America on Social
Security. Application for Benefits Under the Quebec Pension System)—Persons who file
with SSA for QPP benefits from Quebec must complete this form. This form is stocked
in DOs, claims-taking FSPs and OIO.
In addition to the applications, the following Canadian forms have been devised to
process claims under the U.S.-Canadian Agreement/Quebec Understanding:
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5.
CAN/USA 2 (Transmittal and Liaison Form)
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6.
QUE/USA 2 (Transmittal and Liaison Form)