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This change was made on Dec 29, 2017. See latest version.
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GN 01722.035: INSS Referral Letter

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  • Effective Dates: 04/01/2014 - Present
  • Effective Dates: 12/29/2017 - Present
  • BASIC (01-94)
  • GN 01722.035 INSS Referral Letter
  • A. Exhibit — Spanish version
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  • MINISTERIO DE TRABAJO Y SEGURIDAD SOCIAL
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  • Secretaria General para la Seguridad Social
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  • Instituto Nacional de Seguridad Social
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  • Social Security Administration Office of International Operations P.O. Box 17049 Baltimore, MD 21235 Estados Unidos de America
  • Social Security Administration Office of International Operations P.O. Box 17769 Baltimore, MD 21235–7769 Estados Unidos de America
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  • SU REFERENCIA: ..............................
  • PRESTACION: .................................
  • SOLICITANTE: ................................
  • CAUSANTE: ...................................
  • FECHA NACIMIENTO: DD/MM/AA
  • No. DE AFILIACION EN ESPANA:   /  /  .
  • No. DE AFILIACION EN USA:   /  /  .
  • Acusamos recibo de la documentacion de referencia, informandose que con esta misma fecha se remite a:
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  • * DIRECCION PROVINCIAL DEL INSTITUTO NACIONAL DE LA SEGURIDAD SOCIAL DOMICILIO PROVINCIA
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  • competente para el tramite y resolucion del correspondiente expediente y a la que deberan dirigirse en lo sucesivo para todo lo relacionado con dicha peticion.
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  • EL SUBDIRECTOR GENERAL DE GESTION
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  • P.D. LA JEFE DEL SERVICION DE COLABORACION
  • AMINISTRATIVA Y PRESTACIONES A CORTO PLAZO
  • B. Exhibit — English version
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  • Department of Labor and
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  • Social Security
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  • Central Social Security Office
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  • Social Security Administration Office of International Operations P.O. Box 17049 Baltimore, MD 21235 United States of America
  • Social Security Administration Office of International Operations P.O. Box 17769 Baltimore, MD 21235–7769 United States of America
  • YOUR REFERENCE: ...............................
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  • TYPE OF CLAIM: ................................
  • APPLICANT: ....................................
  • WAGE EARNER: ..................................
  • DATE OF BIRTH: DAY/MONTH/YEAR
  • SPANISH SOCIAL SECURITY NUMBER:   /  /  .
  • U.S. SOCIAL SECURITY NUMBER:   /  /  .
  • We acknowledge receipt of the documentation in reference and we inform you that on this same date it is being forwarded to:
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  • * PROVINCIAL OFFICE OF THE NATIONAL
  • INSTITUTE OF SOCIAL SECURITY
  • ADDRESS
  • PROVINCE
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  • competent for the development and adjudication of the corresponding claim and to which all future inquiries regarding said claim must be addressed.
  • THE DEPUTY GENERAL DIRECTOR FOR OPERATIONS
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  • P.D. THE CHIEF OF THE DEPARTMENT OF ADMINISTRATIVE COLLABORATION AND SHORT-TERM BENEFITS
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