SSA - POMS: GN 01743.205 - Developing Evidence and Establishing Entitlement Factors in Claims for Benefits under the U.S. - Australian Totalization Agreement

A. Evidence requirements

1. Submitting evidence

When a person files an application for U.S. Totalization benefits under the Agreement with Australia, the applicant must submit the same evidence that would be necessary to establish eligibility and entitlement for regular (non-Totalization) retirement, survivors, or disability insurance benefits. In addition, whenever applying for Totalization benefits from the United State the applicant must submit the evidence noted in GN 01702.200 through GN 01702.230.

2. Evidence of work in Australia

When determining entitlement to U.S. Totalization benefits under the Agreement, the Social Security Administration (SSA) can only count periods of Australian working life residence when the worker was employed or self-employed. However, since Australia's system is based on residence rather than work, the Australian agency may not be able to determine whether the worker was employed versus self-employed during any particular period of residence. To assist Australian authorities in locating all work-related periods of residence, the applicant should submit any evidence (e.g., pay slips, letters from employers, tax returns) the applicant has showing periods of work in Australia.

B. SSA accepts application for benefits

Under the Agreement with Australia, SSA accepts applications for regular and Totalization benefits on behalf of Australia. SSA also provides limited assistance in obtaining the required evidence to support the applicant’s claim.

C. Using evidence previously submitted in applications for U.S. benefits

Applicants do not need to resubmit the evidence previously submitted and verified to establish factors of entitlement for U.S. Social Security benefits. The evidence previously submitted for entitlement to U.S. Social Security benefits is sufficient to establish the same factors of entitlement to Australian benefits.

D. Establishing entitlement factors

Establish the following factors, in addition to residence requirements, in applications for Australian benefits.

1.
Evidence required for all applications
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  Income and assets of applicant
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  Identity of applicant
2.
Evidence required for applications for retirement benefits
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  Date of birth of applicant
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  Date of birth of child(ren) under age 16 and relationship, if a supplement or parenting payment is claimed.
3.
Evidence required for applications for survivors benefits
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  Date of death of individual
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  Date of birth of child(ren) under age 16 and relationship, if a parenting payment is claimed.
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  Date of marriage, if a bereavement payment/allowance is claimed.
4.
Evidence required for applications for disability benefits
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  Degree of disability
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  Date of birth of child(ren) under age 16 and relationship, if a supplement is claimed.

E. Developing evidence in support of an applicant for retirement, survivors, or disability benefits

Take the following actions when developing evidence to support applications for Australian benefits.

1.
Researching types of evidence

Refer to the following policy if the applicant requests guidance on the types of evidence to submit:
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  GN 00302.000 Proof of age
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  GN 00304.000 Proof of death
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  GN 00306.000 Proof of parent/child relationship
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  GN 01743.220 Proof of identity in section A of the special application for Australian benefits
2.
Accepting evidence

Whenever Totalization benefits are claimed from Australia the applicant must submit the evidence noted in GN 01702.200 - GN 01702.230.
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  SSA accepts any evidence the applicant submits;
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  Photocopy the evidence, certify the copies, and return the original to the applicant. See GN 00301.105 for information concerning certifying evidence for Totalization claims;
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  Complete the Modernized Development Worksheet (MDW) screen to show the date the FO sent the Australian claim to DIO. Show, "Totalization" as the ISSUE;
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  Inform the applicant that the responsible Australian agency will contact them directly to obtain any additional documents or evidence to make a determination.
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  Send the claim to the Division of International Operations (DIO) at the following address without the evidence if an applicant is unable to obtain the necessary evidence within a reasonable period.
  
  NOTE: Do not hold claims for Australian benefits for prolonged periods pending receipt of evidence.
  
  Social Security Administration
  
  OEIO - DIO
  
  P.O. Box 17769
  
  Baltimore, MD 21235-7769
  
  Fax number: 410-966-1961
  
  NOTE: If courier service is used, mail to:
  
  Social Security Administration
  
  Division of International Operations
  
  6100 Wabash Avenue
  
  Baltimore, MD 21235
3.
Documenting the file

Document the file as follows:
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  Indicate on the Australian benefit claim file any factor of entitlement verified previously for the U.S. claim;
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  For concurrent Title II claims, send the Title II claim and relevant evidence to the Program Service Center (PSC) of jurisdiction;
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  Electronically send a certified photocopy of the relevant evidence with the Australian claim to DIO; and
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  If a prior Title II claim was filed, include a Master Beneficiary Record (MBR) to DIO to show which factors, other than disability, have been verified..
4.
Obtaining the number holder's (NH's) U.S earnings record

Obtain the NH's U.S. earnings record in all claims for Australian benefits as follows:
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  When the applicant is filing for both U.S. and Australian benefits, complete the Modernized Claims System (MCS) screens. The MSC screens will automatically generate a separate earnings record for the Australian claim;
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  When the applicant files for Australian benefits only, which is an MCS exclusion, request an Informational/Certified earnings record (ICER) per MS 02101.004; and
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  Obtain proof of lag earnings (unposted paid earnings in the current or preceding year) if U.S. covered work in the lag period is alleged and the applicant is filing for any Australian benefit.
  
  For proof of lag wages, see RS 01404.005 and RS 01404.018. For proof of lag self-employment income, see RS 01804.100.

F. Developing medical evidence for disability claims

In addition to taking the actions in GN 01743.205E., take the following actions when developing medical evidence for Australian disability claims.

1.
Australian benefits only
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  Accept any medical evidence the applicant submits for Australian benefits. Do not attempt to secure evidence for the applicant or offer advice as to what types of evidence Australia may need.
NOTE: Applicants for Australian disability benefits must also complete a Work Ability form (WA) which is available on the intranet, see GN 01743.220.
- •
  
  Send all submitted medical evidence and claims file to DIO at the following address:
Social Security Administration

OEIO - DIO

P.O. Box 17769

Baltimore, Maryland 21235-7769

USA

Fax number: 410-966-1861

NOTE: For information about routing of claims for U.S. benefits involving Totalization, see GN 01702.310
- •
  
  Complete the Modernized Development Worksheet (MDW) screen to show the date the FO sent the Australian claim to DIO. Show "Totalization" as the ISSUE, and
- •
  
  Transmit the file without medical evidence if it is not readily available.
Advise the applicant that the Australian agency will contact them directly to obtain any required evidence.
2.
Australian benefits and concurrent Title II Claim
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  Follow the instructions in GN 01702.400 - GN 01702.415.
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  Advise the applicant to complete a Work Ability form that is available on the intranet, see GN 01743.220.

G. References

•

GN 00301.105 Certifying evidence for Totalization Claims.
•

GN 00302.000 Proof of Age
•

GN 00304.000 Proof of Death
•

GN 00305.000 Proof of Marital Relationship
•

GN 00306.000 Child Relationship and Dependency
•

GN 01702.110 Application for Benefits under a U.S. International Social Security (Totalization) Agreement (Form SSA-2490-BK)
•

GN 01702.125 Retroactive Life of Applications for Foreign Benefits
•

GN 01702.130 Prospective Life of Applications for Foreign Benefits
•

GN 01702.400 Developing Medical Evidence in Claims for U.S. Totalization Disability Benefits
•

GN 01702.415 Development of Medical Evidence and Routing of Claims for Foreign Disability Benefits
•

MS 02101.004 Informational/Certified Earnings Records - Totalization (ICIC)
•

GN 01743.215 Application for Benefits under the Australian Agreement
•

MS 03507.001 Introduction to SSA-2490 - Overview
•

MS 03509.011 Totalization (TOTL) screen
•

RS 01301.000 Living With, Contributions and One-Half Support
•

RS 01404.005 Lag earnings

Social Security

Program Operations Manual System (POMS)

GN 01743.205 Developing Evidence and Establishing Entitlement Factors in Claims for Benefits under the U.S. - Australian Totalization Agreement