TN 1 (04-19)

GN 01758.310 Brazilian National Social Insurance Institute (Brazilian Liaison Agency) Requests for Medical Examinations

A. Background – INSS requests a medical examination

If the Brazilian liaison agency, the National Social Insurance Institute (INSS) requests a medical examination for a U.S. resident, the Social Security Administration (SSA) will schedule the examination and send the results to INSS.

B. Process for INSS to obtain medical examinations

To obtain medical examinations for INSS, use the following process:

1. INSS request for medical examinations

INSS requests medical examinations using the Form SSA 2960 USA/BR 3 (U.S. Brazil Agreement on the Social Security Transmittal/Request/Certification).

2. SSA Schedules an examination or forwards pertinent medical evidence

Pertinent medical evidence is medical evidence that SSA obtained in connection with a continuing disability review or a disability claim filed or adjudicated within a year of the date for which INSS has specifically requested medical evidence. SSA schedules an examination, or forwards “pertinent medical evidence” from SSA files to INSS. SSA’s files include a paper claims folder and electronic files.

3. SSA requests reimbursement for cost of medical examinations

SSA requests reimbursements for the cost of medical examinations obtained for INSS using form 1278 USA/BR 9 Request for Payments of Reimbursable Expenses under U.S. Brazil Agreement on Social Security. Once the form is completed, scan it into electronic file and send a copy to:

Address:

Social Security Agency Attendance of International Agreement
Avenue: Amazonas nº 266
9º floor, 901 room Center Belo Horizonte
Minas Gerais --CEP: 30180-001
Brazil

NOTE: You can print this form from the SSA Totalization Forms section of the Division of International Operation’s “Totalization Resource Kit”.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201758310
GN 01758.310 - Brazilian National Social Insurance Institute (Brazilian Liaison Agency) Requests for Medical Examinations - 04/09/2019
Batch run: 04/09/2019
Rev:04/09/2019