Most individuals filing for Old-Age Security (OAS) and Canada Pension Plan (CPP) benefits should be able to fill out the CDN-USA 1 without assistance using the completion instructions provided with the application. Should a claimant require assistance in completing the form, refer to the item-by-item instructions starting on page 8 of the instruction guide.

Sections 1 and 6 of the CDN-USA 1 each contain a block headed “FOR USE BY THE SOCIAL SECURITY ADMINISTRATION ONLY.” These blocks are completed only by staff in the Office of International Operations (OIO) or one of the designated border offices identified in GN 01715.320. The blocks are used to inform the Canadian agency which, if any, of the items identified in sections 1 and 6 have been verified for SSA purposes.

Always complete the “DATE OF RECEIPT” to show the date claim filed. Enter the date the CDN-USA 1 is filed in the field office (FO) or, if applicable, an earlier protective filing date.

Enter your initial in the “VERIFIED BY:” space.

Make entries next to the dates in Sections 1 and 6 only if SSA has established the relevant date in connection with a concurrent retirement, survivors or disability claim, or the date was previously established in connection with a prior claim and the date is available from the master beneficiary record (MBR). When an alleged date has been proven for SSA purposes, check the box beside “AS STATED.” If SSA has established a date different than the one alleged by the claimant, check the box next to the blank line and enter the proven date on the line. The proper date should be entered in year, month, and day order. (EXAMPLE: if the date of birth is January 2, 1935, enter 1935/Jan/02.) If SSA has not established an alleged date, make no entry by that date. If any entries are made next to the dates in Section 6, enter your initials in the “VERIFIED BY:” space.