Basic (10-23)
GN 01772.325 Social Security Administration (SSA) Medical Exam Reimbursement Form
SSA uses the Form SSA 1278 U.S.- IS 9 (Request for Payment of Reimbursable Expenses
under U.S.A.–Iceland Agreement on Social Security) for reimbursement of medical expenses
regarding requests for exams.
The Form SSA 1278 U.S.- IS 9 (Request for Payment of Reimbursable Expenses under U.S.A.
– Iceland Agreement on Social Security) is available on the SSA Totalization Forms
section of the Office of Earnings and International Operations, Division of International
Operations, Totalization Resource Kit.
Mail the form to:
For Disability Claims:
Social
Insurance Administration
Tryggingastofnun
International
Hlíðasmári 11,
201 Kópavogur
Iceland