DI 43535: Totalization Assistance Requests
BASIC (03-86)
| Exhibit No. | |
|---|---|
| Transmittal Slip for Claims Folder (SSA-559) | 1 |
| Certificato Medico | 2 |
| D/USA 3 Agreement FRG/SSA | 3 |
| D/USA 6A Medical Request Form (FRG) | 4 |
| D/USA 7 Consent Declaration (FRG) | 5 |
| Form SSA-847-U3 (Medical Development Request--General) | 6 |
| Form SSA-847-U3 (Medical Development Request Follow-up) | 6A |
| Form SSA-1278-U3-IT (Italian Reimbursement) | 7 |
| Form SSA-1278-U3-GE (German Reimbursement) | 8 |
| Form SSA-1278-U3-SZ (Swiss Reimbursement) | 9 |
Exhibit 1--Transmittal Slip for Claims Folder (SSA-559)
Exhibit 2--Certificato Medico
Exhibit 3--D/USA 3 Agreement FRG/SSA
Exhibit 4--D/USA 6A Medical Request Form (FRG)
Exhibit 5--D/USA 7 Consent Declaration (FRG)
Exhibit 6--Form SSA-847-U3 (Medical Development Request--General)
Exhibit 6A--Form SSA-847-U3 (Medical Development Request Follow-up)
Exhibit 7--Form SSA-1278-U3-IT (Italian Reimbursement)
Exhibit 8--Form SSA-1278-U3-GE (German Reimbursement)
Exhibit 9--Form SSA-1278-U3-SZ (Swiss Reimbursement)
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