TN 1 (04-94)

A. List of form CDN/USA 2 functions

Ottawa uses Form CDN/USA 2 to:

• transmit claims and related material to border FOs.

• send information requested by DIO or the border FOs to DIO.

• request information from DIO.

B. Process — FORM CDN/USA 2

Most entries on the form are self explanatory with the exception of those specifically listed below:

1. Part 2.f.

Evidence of Coverage Periods

• Ottawa checks this block when they are providing a record of Canadian coverage for someone who has filed for U.S. benefits.

• When a person has no coverage in Canada, Ottawa enters a zero in the total block.

• When coverage appears in this section for a year after the year of alleged disability onset, Ottawa will provide information if the coverage is based on work.

2. Part 2.g.

Certification of Data

• Ottawa uses this section to certify the date claim filed and vital statistics data pertaining to the worker and his family taken from their records.

• These dates will be used without further verification unless there is a material discrepancy with other evidence in file (See GN 01701.210).

3. Part 3

Information Required From United States

• Ottawa has provided a statement at the beginning of the section which eliminates the need for a copy of the individual's consent before we can release the requested information.

• Ottawa will provide a consent form require information about an individual who has not filed a claim under the agreement.

4. Part 3.c.

Medical Evidence

• Ottawa checks the block to request a copy of medical evidence in DIO files.

• If there is no medical evidence in file, the remarks portion of the SSA-e2960-U3-CQ will show, “No Medical Evidence in File.”

• Do not request a medical examination.

C. Exhibit

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