TN 4 (12-12)

A. Description of the e4962

The e4962, Totalization Data Collection Form, is an electronic form that replaces the paper Totalization Data Collection Form SSA-4962-U2. The purpose of the e4962 is to collect necessary data on the claims and foreign assistance requests received in the Division of International Operations (DIO), the Federal Benefits Units overseas, and the Canadian border Offices.

B. Policy for completing the e4962

You must initially complete the electronic e4962 in the Totalization Data Collection Program (TDCP) to establish a record for every Totalization claim and foreign agency assistance request received in DIO.

You must complete the e4962 to correct, update, and clear records established in the program. In order for TDCP reports to reflect current and accurate statistics, it is important that you code and key the receipts as soon as you receive them, or in the case of earnings record receipts, at the time you release the package.

The Social Security Number (SSN), Agreement code, and Receipt code are the key items that identify an individual record in the TDCP. Unlike most computer programs at SSA, you cannot identify a record by an SSN alone in the TDCP; the system must also specify the Agreement Code and Receipt Code.

For purposes of the TDCP, you may define a record as any different combination of SSN, Agreement code, and Receipt code.

EXAMPLE: If there are claims filed under both the Italian and German agreements on the same case and you receive assistance requests from both INPS and a German agency, the TDCP would contain four separate and distinct records, even though the SSN was the same for each.

C. Process for entering and clearing items in the TDCP

The following statements describe the process for entering and clearing items in the TDCP and indicate the technician responsible for completing these forms.

Count an application or an assistance request as a receipt when entered into the TDCP (via a transaction A). The TDCP carries this as a pending item, until the system clears it. Items not cleared timely, adversely affect the office processing times, as reflected in the TDCP. The information that the TDCP needs to clear a record depends on the type of receipt and (for applications) the category.

When you receive an assistance request for only an earnings record from a foreign agency and there is an Office of Earnings Operations (OEO) condition on the earnings record, do not complete an e4962. Create a diary pending the receipt of the earnings record. There is a delay in the e4962 process until the Division of Earnings Records Operations (DERO) resolves the condition. When you send the package to the foreign agency, enter, and clear the assistance request simultaneously into the TDCP.

The Claims Technical Examiner (CTE), Claims Representative (CR), or Benefit and Earnings Technician (BET) are responsible for completion of the e4962 depending on various factors, such as the type of receipt or the category.

• The first person who reviews the receipt should complete the e4962 to the extent possible, unless it is only an assistance request for an earnings record. The CR or CTE, generally records applications containing concurrent RSDI or Totalization claims.

• Subsequent Totalization claims and assistance requests usually fall within the jurisdiction of the BET, CR, or CTE depending on the situation.

• In many cases, data coding is the responsibility of the CR, CTE, and BET.

EXAMPLE: On a concurrent RSDI/Totalization claim, the CTE or CR should record the appropriate data for Parts I, II, III, and IV. Depending on the agreement and insured status, the CTE or CR (domestic only) also may be able to complete the “U.S. Totalization claim” portion of Part VI. The BET is responsible for preparing another e4962 to record the “Package or Reply Date,” in Part VI (and possibly the foreign agency development information in part V). The CTE or CR (domestic only) receives the foreign earnings record and makes the final decision on the U.S. Totalization claim. The CTE or CR (domestic only) prepares another e4962 containing the SSN, Agreement and Receipt codes, the “Receipt Date in Office” in Part IV, and the “Authorization Date” and “TSC” in Part VI. The CTE or CR (domestic only) uses Transaction “C” to make the change.

NOTE: The TDCP database houses electronic copies of all completed forms for three years.

D. Procedure for completing the e4962

Complete the information on the e4962 via the TDCP as follows:

1. Section I - Identification

Always complete Section I in its entirety.

NOTE: The TDCP can accommodate multiple receipts under multiple agreements for any SSN. Under TDCP, a combination of SSN, Agreement code, and Receipt code defines a TDCP record. The SSN alone will not identify a TDCP record.

• SSN: Always enter the 9-digit U.S. SSN in the blocks provided.

• Agreement: Select the appropriate Totalization country from the drop down menu to indicate the agreement that the application or assistance request applies.

  NOTE: As new agreements become effective, your DIO TDCP Administrator will add the new country into the TDCP database.

• Receipt: Select the appropriate code from the drop down menu to indicate the type of receipt.

  NOTE: TDCP can accommodate up to two applications and two assistance requests per agreement for each SSN. Therefore, it is essential that you show the correct Receipt code, along with the SSN, and Agreement code to ensure that you identify the proper record under the proper agreement.

a. Application 1

Select this code from the drop down menu to record the initial application receipt for each agreement on the same SSN.

NOTE: Consider a supplemental application obtained to change a filing restriction or a response to an unanswered question, e.g., part of the initial application.

Usually, the application that you code data from is the SSA-2490, Application for Benefits under a U.S. International Social Security (Totalization) Agreement. However, if a foreign application, such as a D/USA 1, US/Italy 1, etc. is the only application received on the case, code the data from that application. In addition, you may code data from the U.S. national applications from the Direction de l'Administration des ententes de securite sociale (DAESS) in Quebec, Canada.

b. Assistance Request 2

Select this code from the drop down menu to record the initial foreign agency assistance request for each agreement on the same SSN. Treat follow-up requests as part of the initial request; i.e., do not code them as additional requests.

c. Application 3 (DIB after Death)

Select this code from the drop down menu to record any additional applications under the same SSN and same agreement. For purposes of the TDCP, this “additional application” pertains to situations where a worker, who files a Totalization application, dies prior to adjudication, and requires a surviving claimant to complete another Totalization application. The “additional application” also pertains to “disability insurance benefits (DIB) after death” claims filed by persons who already filed claims for survivor's benefits.

d. Assistance request 4 (Follow-Up)

Select this code from the drop down menu to record any subsequent assistance request under the same SSN and same agreement. Treat this request as a subsequent request, if the information requested is new or different from the information initially requested.

2. Section II- transaction code

Select the appropriate code from the drop down menus as follows:

1. (ADD): Select this code to add a new record to the TDCP.

   Note: You must record every Totalization application and foreign assistance request received in DIO on the TDCP via transaction code A.

2. (CHANGE): Select this code from the drop down menu to correct information for a record that already exists on the TDCP. Use this code to update or add data as long as the record is still pending on the TDCP.

   Select this code from the drop down menu to record the U.S. Totalization Claim Authorization Date for a pending TDCP record. No entries required in Parts III, IV, or V of the form.

   Exception: If you previously requested foreign agency development (Part V-A) and entered the information onto TDCP, you must record the receipt of that development in Part V-C, in order for this action to work.

   Use the Change transaction code to update the following to a pending TDCP record.

   • date claims package sent to the foreign agency, or

   • date of reply sent to a foreign agency.

     NOTE: If the DIO receipt date (IV-D) is incorrect on TDCP, a transaction C and the correct date are the only items that you must code, in addition to the mandatory SSN, Agreement code, and Receipt code. You cannot use this code to correct the SSN, Agreement code, or Receipt code.

3. (DELETION): Select this code from the drop down menu to delete a record from the TDCP pending file. You will mostly use this code to correct the SSN, Agreement code, or Receipt code.

Also, use this code, including the SSN, Agreement code, and Receipt codes to delete a withdrawn claim from the TDCP pending file.

Note: After you select a transaction code D to delete an erroneous record, you must select a new transaction code A form to establish the new record.

3. Section III - Characteristics

Complete Section III - Characteristics for application receipts only. Complete this section on all transaction A forms and transaction C forms when you correct information in Part III.

Note: Never complete this section for transaction D forms or for assistance requests (receipt code 2 or 4).

Category:

• Select the appropriate code from the drop down menu to indicate whether the application is for both U.S. and foreign benefits (1), is restricted to U.S. only (2), or restricted to foreign benefits only (3).

• Determine the correct category from question 2 of the Totalization application, the SSA-2490-F4. If you receive an application for only foreign benefits, e.g., a D/USA 1, select category 3.

• Determine the category based on what DIO receives. Thus, if a border DO or FSP sends a foreign claim directly to the foreign agency and forwards only the U.S. claim to DIO, code the application as category 2 (U.S. only).

• Select the appropriate code from the drop down menu code list to indicate type (retirement, disability, etc.) of benefits claimed. Determine the type from question 2 of the SSA-2490-F4.

Note: Enter only one code per form. In most category 1 (U.S. and foreign) claims, the types of benefits claimed are the same. However, because of the differences in eligibility factors, a claimant may occasionally apply for different types of benefits from each country (e.g., U.S. retirement and foreign disability). In this situation, indicate type code 5 (OTHER).

4. Section IV - Filing and request information

Complete this section to obtain specific filing information for applications and assistance requests.

(A) Office Code - Select the appropriate code from the drop down menu to indicate the office type that filed the application. Since all assistance requests are from foreign agencies, “3” is the only option available in the assistance request column. If appropriate, select an office code. The office code selections are:

• F.O. - Field or district offices including DIO and VARO in Manila.

• F.S.P. - U.S. Foreign Service Posts.

• FOR. AGCY. - Foreign agencies (including claims that originate in Quebec, but routed through border DOs).

Other - Other offices (including claims filed directly with the DIO).

(B) Foreign agency code - For assistance requests, select the 3-digit code from the drop down menu or click on the “List” button option indicating the specific foreign agency that requested assistance. Do not make an entry for claims (applications) received in DIO.

(C) Application date – Click on the Application Date Calendar, and select the filing date of the Totalization application. This date is generally located in the block labeled “Do not write in this space” in the upper right hand corner of the SSA-2490-F4, or the upper left on the SSA-2528, Medical Evidence (IT/USA 1). If you cannot locate the date in that block, you can locate the date on the back of the form. If there is more than one date shown, use the earliest date. Never complete this block for assistance requests.

NOTE: Since we are attempting to measure processing time from the receipt of the actual application, the date entered on the e4962-U2 will not always correspond to an established protective filing date.

(D) Office receipt date – Click on the Office Receipt Date Calendar and select the date your office received the Totalization application or foreign agency assistance request. You should stamp the date on the back of the application form (date of Modernized Claims System (MCS) input) or assistance request. If there is no date stamp, use the current date.

5. Section V - foreign agency development

Complete section V - Foreign Agency Development to capture the number of development requests sent, the number pending with foreign agencies, and the processing time.

When requesting development for U.S. claim, complete section A and B of the e4962; complete section C upon receipt of the reply.

NOTE: If the case does not require a development request to the foreign agency, there are no required entries for Part V. Do not complete this section for an assistance request or for a Category 3 application. The transmittal of a package to a foreign agency constitutes a development request only if it includes a request for information (usually an earnings record); without which, you cannot finally adjudicate the Totalization claim.

Record foreign agency development information as it occurs.

Example: When you request development from a foreign agency, complete the request date and agency code information. The TDCP will carry this as a pending item until it receives an indication that the office received this development. Thus, when you receive the development, you must record the receipt date in block (C). In addition, the receipt of the development from the foreign agency will generally permit the CTE or CR (domestic only) to complete final adjudication of the U.S. Totalization claim.

(A) Date requested – Click on the Date Requested Calendar and select the date the request to the foreign agency was prepared by the office. If you do not request information from the foreign agency, leave this block blank.

(B) Foreign agency code - Select the 3-digit code from the drop down menu or click on the “List” button option for the specific foreign agency where you sent the request. Complete this block if an entry is in the "Date Requested" (block A); otherwise, leave it blank.

(C) Receipt date in office - Click on the “Receipt Date” calendar and select the receipt date of the foreign agency's response. You must complete this block when you receive development from a foreign agency.

If you select a transaction code A, this entry must accompany the entries in the "Date Requested" and “Foreign Agency Code” blocks.

If you select a transaction code C, you can code this entry independently of the “Date Requested” and “Foreign Agency Code” blocks, but must accompany the entries in the “Authorization Date” and “TSC” blocks in Part VI. Failure to record the receipt date will prohibit the entry of the U.S. authorization date in Part VI.

6. Section VI - Final status

Part VI of the e4962 is SSA's final disposition of the U.S. Totalization claim and the foreign claim or foreign agency assistance request.

• If the receipt is an assistance request or an application for foreign benefits only (category 3), click on the “Package or Reply Date” calendar and select the appropriate date to clear it from the TDCP.

• If there is an application for U.S. benefits only (category 2), click on the “Authorization Date” calendar and select the appropriate date and click on the “TSC” drop down menu or “List” button, and select the appropriate TSC code to clear TDCP.

• If the receipt is an application for both U.S. and foreign benefits (category 1), click on the Authorization Date Calendar and select the appropriate date, and click on the TSC drop down menu or List button for the appropriate TSC code to produce a clearance. For many category 1 applications, the CTE or CR (domestic only) can select the U.S. Totalization claim authorization date at the time the record is first established; i.e., when preparing a transaction A. This happens often on cases where the final TSC is D1, D3, or D4. (You can also enter this information on transaction C forms.)

Selecting the TSC code from the drop down menu in the TDCP is very important. Statistics on the number of Totalization claims processed will be unavailable from any other source throughout SSA. It is imperative that you make timely and accurate TSC entries.

(A) U.S. Totalization Claim - Authorization Date - Select the appropriate date from the Authorization Date Calendar the U.S. Totalization claim finally adjudicates. The final authorization date will be the date the CTE or CR (domestic only) either awards or denies Totalization benefits, or the denial date of the claim on MCS.

For foreign agency assistance requests (code 2 or 4 receipts) or claims restricted to foreign benefits only (category 3 application), do not make a selection.

TSC (Totalization Status Code) - Select the final TSC code from the drop down menu applicable to the U.S. Totalization claim. If there is a date in the “Authorization Date” block, select a TSC code. For a list of codes, see GN 01703.230D.

(B) Foreign claim or request - Package or reply date - Applications - Select the appropriate date from the calendar drop down menu that the claimant initially filed an application for foreign benefits with SSA and transmit to the appropriate foreign agency. No date is necessary for any subsequent packages.

The date will generally be the same date you requested any necessary development from a foreign agency; i.e., the same date entered in Part V. No date is necessary for category 2 (U.S. only) applications.

NOTE: If under the Canadian agreement, it is necessary to send a claims package to both the Canada Pension Plan and the Quebec Pension Plan, use the date that you send the later package.

Assistance Requests - Select the date that you send the final reply to the foreign agency.

E. Examples of completing the e4962s

The examples illustrate how and who completes the e4962 in the following hypothetical situations.

Example 1: Uninsured worker

An uninsured worker visits an FO on November 7, 1993 and files concurrent RSDI or Totalization claims for both U.S. and German retirement benefits. DIO receives the claim on December 5, 1993.

Since the CTE or CR is establishing this record for the first time, indicate transaction A. The CTE or CR is able to record complete information in parts II, III, and IV. However, the CTE or CR cannot complete information in parts V and VI at this time.

After you complete the action on the RSDI claim, prepare the claims package for the German agency and a request for the German earnings record. On December 20, 1993, the CTE or CR (foreign only) releases the package to the BfA in Germany. Since the e4962 completed by the CTE or CR established the record, the CTE or CR now prepares a transaction C form to update the record with the new information.

When you receive the development, add the receipt date for the development requested from the foreign agency (block C in Part V) and the U.S. Totalization claim authorization date, and TSC in Part VI to the program. In the meantime, the TDCP carries the record as a pending item.

On April 19, 1994, you receive the requested earnings record from the BfA and, on May 28, 1994, the CTE awards U.S. Totalization benefits. Utilizing transaction C, the CTE now records the receipt date in Part V and the final status of the U.S. Totalization claim in Part VI.

Example 2: Insured worker

Same as in EXAMPLE 1, except that the worker is insured based on U.S. coverage. On December 17, 1993, the CTE recognizes the denied Totalization claim (TSC D3) and records the data in Part VI.

On January 7, 1994, the BET or CR (foreign only) prepares the claims package for the German agency; but since the worker is insured, there is no need to request a German earnings record. The data previously coded by the CTE is correct, and the U.S. authorization was included. Therefore, the BET or CR (foreign only) can prepare a transaction C form to indicate the date the package was sent.

F. List of foreign agency codes

The following list provides the foreign agency codes: