TN 2 (09-85)

GN 01704.425 Reviewing Totalization Applications

A. Italian Agreement—Forms SSA-3954-BK-IT

BETs are responsible for the completeness and the correctness of the Form SSA-3954-BK-IT. They must resolve discrepant entries and they must especially be alert to the omission of data for persons who could be entitled to benefits under Italy's system, but who could not be entitled to benefits from the United States (e.g., the wife of a worker may be entitled to benefits at any age—there is no requirement that a wife be 62 or have a child in care; children up to age 26 attending a university; in survivor cases, widows and widowers at any age and under certain circumstances, brothers and/or sisters of the deceased worker). No action is required to develop for auxiliaries who might be entitled to benefits from Italy, if the Form SSA-3954-BK-IT was filed in Italy. BETs must review the Form SSA-3954-BK-IT item-by-item according to GN 01705.215. They correct and/or resolve omissions and discrepancies by requesting the necessary information from DOs or FSPs. Furthermore, BETs are responsible for obtaining military service information about the worker not available on the obsolete Forms SSA-3954-F8-IT.

B. German Agreement

1. FORM SSA-3957-F6

BETs are responsible for the completeness and the correctness of Form SSA-3957-F6. Although BETs may not make decisions concerning the possible entitlement of a claimant to German benefits, they must be familiar with the types of benefits payable by Germany (GN 01707.020) in order to make a meaningful item-by-item review of the Form SSA-3957-F6, according to GN 01707.215.


Request either a Form D/USA 1 or D/USA 2 if the claimant is a U.S. resident filing for benefits from West Germany and has submitted neither form. Review the applications D/USA 1 or D/USA 2 to ensure they display the worker's name, date of birth and SSN or German insurance number, and also to ensure the applications have been signed and dated by the applicant. If any of this data is missing, send a supplementary application to the applicant for completion. Check the required items in red and attach a request to complete the items checked in red. Diary the request for 60 days. If no response has been received from the applicant at end of diary period, check the address. If correct, contact the parallel DO for assistance. If the address was incorrect, remail the supplementary application to the applicant.


Obtain Form D/USA 8 if the NH is not insured for RSDI benefits, has at least six QCs, is filing for benefits from the U.S. only and has never filed for German benefits.

C. Swiss Agreement—Form SSA-4231-F6

  1. 1. 

    Review Form SSA-4231-F6 for correctness and completeness. In addition, if the claimant resides in the United States and is filing for benefits from Switzerland:

    1. a. 

      If claimant is a Swiss national, refer him/her to a Swiss consular office in the United States by sending a notice consisting of paragraph 17180. (See NL 00711.310.)

    2. b. 

      If the claimant is a U.S. citizen, send him/her a CH/USA 2.1., CH/ USA 2.2 or CH/USA 2.3 using paragraph 17181. (See NL 00711.310.) There is no space for an SSN on these applications; therefore, be sure to show the U.S. SSN in the upper right-hand corner. Enclose the application(s) and a return envelope(s) preaddressed to: Social Security Administration, International Program Service Center—Totalization, P.O. Box 17049, Baltimore, Maryland 21235. Photocopy the notice and place the photocopy in the blue folder for documentation. Also prepare a 60-day diary. If no response is received after carefully checking the name, address and SSN displayed on the first notice, prepare a second notice, include a preaddressed return envelope and diary for 30 days. If no response is received, forward the SSA-4231-F6 to the CSC via an SSA-2960-U4SZ. Annotate the “Remarks” section: “Claimant did not respond to 2 requests to complete an application for Swiss benefits.”

    3. c. 

      If the claimant is a refugee or stateless person, follow b. above.

    4. d. 

      If the claimant is a third country national, he/she can qualify for Swiss benefits only if he/she derives rights from a U.S. or Swiss citizen or a person who is a refugee or stateless. Refer these cases to a CA to determine whether or not the claimant has derived rights.

      1. 1. 

        If claimant has derived rights, follow b. above;

      2. 2. 

        If claimant does not have derived rights, inform the CSC that a claim has been filed by a third country national on a liaison form. DO NOT SEND THE CSC THE FORM SSA-4231-F6.

D. Norwegian Agreement—Form SSA-796

Review Form SSA-796 for correctness and completeness. In addition, if CAs have not already done so, send the appropriate applications to claimants for Norwegian benefits who are filing in the United States. Along with the appropriate application, send a notice stating:


    The Norwegian Insurance Institute requires the completion of the enclosed application to adjudicate your claim for a pension. Therefore, please complete the application, sign it and mail it directly to:

    Folketrygdkontoret for Utenlandssaker
    Post Office Box 8131, 0033 Oslo 1

    If you have questions concerning the processing of your claim for a pension from Norway, contact the agency at the Norwegian address shown above. That agency will notify you by mail concerning your eligibility under its laws when a decision has been reached.

Preprinted notices containing this statement should be used unless information not shown on the preprinted notice is necessary.

E. Belgian Agreement—Form SSA-799-F4

Review Form SSA-799-F4 for correctness and completeness. Although the application will not be sent to Belgium, information from the form is used to inform the Belgian agency about the claim. (See GN 01704.716 D.)

F. Canadian Agreement/Quebec Understanding—Form SSA-1294

1. SSA-1294-F5

BETs are responsible for the completeness and correctness of the responses on this form, which should only be completed if individuals are filing for benefits from the U.S. under the Canadian Agreement/Quebec Understanding. This form is not completed by claimants filing in the Province of Quebec.


Ensure type of benefit claimed information has been completed; i.e., a claimant for retirement benefits on his/her own behalf must answer the questions in sections 1, 2 and 5, but need not complete sections 3 and 4.

If claimant's signature is not witnessed, take no action—the claimant's rights are fully protected. Ottawa will secure a witnessed signature.

Ensure that the “To be completed by the Competent Institution in the United States” on the CAN/USA 1 and the “To be Completed by the Competent U.S. Agency” on the QUE/USA 1 sections are completed if the applications are being sent to Canada from OIO. Date claim filed and limited vital statistic data is certified directly on these forms.

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GN 01704.425 - Reviewing Totalization Applications - 08/08/2014
Batch run: 10/17/2016