BASIC (09-02)

A. Introduction

All applicants for Australian benefits must complete a special application form (Form AUS140–US(A).0210). This form has two parts. Part A contains instructions for completing the form and Part B is the actual application. Since Australian benefits are income/resource tested, all applicants must also complete Form Mod (i) listing their income and assets. In addition, applicants for Australian disability benefits must also complete a Work Ability-Customer Information form (Form WA) showing how their disabilities impact their daily activities.

B. Procedure

The special Australian forms are taken in the field offices (FO's). If an applicant wishes to file for Australian benefits, the FO should:

1. Access the Totalization Benefits Resource Kit on the intranet at http://ocoweb.ba.ssa.gov/oio/Totalization/TotResKit.asp.

2. Print Part A and B of the Australian application form (Form AUS140–US(A).0210) and income and assets form (Form Mod i) and give them to the applicant for completion.

3. If the applicant is filing for disability benefits, also print the Work Ability form (Form WA) and give it to the applicant for completion.

4. Provide any necessary assistance in completing the Australian forms.

5. Photocopy and certify any documents (evidence) submitted by the applicant.

6. Send the claim (with certified copies) to OIO in Baltimore at the address shown in GN 01702.310.

Once OIO receives the claim, OIO will send the claim directly to the Australian agency along with a copy of the applicant's U.S. coverage record.

NOTE: Most individuals filing for Australian benefits should be able to complete the Australian forms without assistance using the instructions provided with the application.