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© Nature of self-employment activity;
© Dates the activity was or will be performed; and
© Name and address of your trade or business in both countries.

Effective Date Of Coverage Exemption

The certificate of coverage you receive from one country will show the effective date of your exemption from paying Social Security
taxes in the other country. Generally, this will be the date you began working in the other country.

Certificates of coverage issued by Spain should be retained by the employer in the United States in case of an audit by the Internal
Revenue Service (IRS). No copies should be sent to IRS unless specifically requested by IRS. However, a self-employed individual
must attach a photocopy of the certificate to his or her tax return each year as proof of the U.S. exemption.

Copies of certificates of coverage issued by the United States will be provided for both the employee and the employer. It will be
their responsibility to present the certificate to the Spanish authorities when requested to do so. To avoid any difficulties, your
employer (or you, if you are self-employed) should request a certificate as early as possible, preferably before your work in the
other country begins.

If you or your employer request a certificate of coverage, you should read the Privacy Act and Paperwork Reduction Act Statements
below.

If You Submit Information or Answer Questions To Request A Certificate Of Coverage
Privacy Act and Paperwork Reduction Act Statements
Privacy Act

|The Privacy Act requires us to notify you that we are authorized to collect this information by section 233 of the Social Security Act.

hile it is not mandatory for you to furnish the information to the Social Security Administration (SSA), a certificate of coverage
cannot be issued unless a request has been received. The information is needed to enable SSA to determine if work should be
covered only under the U.S. Social Security system in accordance with an international agreement. Without the certificate, work
Imay be subject to taxation under both the U.S. and the foreign Social Security systems.

Paperwork Reduction Act Notice

[This information collection meets the clearance requirements of 44 U.S.C. section 3507, as amended by section 2 of the Paperwork

Reduction Act of 1995. You are not required to answer these questions unless we display a valid Office of Management and Budget

(OMB) control number. We estimate that it will take you about 30 minutes to read the instructions, gather the necessary facts, and
rite down the information to request a certificate of coverage.

Monthly Benefits

The following table shows the various types of Social Security benefits payable under the U.S. and Spanish Social Security systems
and briefly describes the eligibility requirements that normally apply for each type of benefit. If you don’t meet the normal
requirements for these benefits, the agreement may help you to qualify (see "How Benefits Can Be Paid" section).

This table is only a general guide. You can get more specific information about U.S. benefits here on our web site or at any U.S.
Social Security office or by calling our toll-free number at 1-800-772-1213. You can get more detailed information about the
Spanish system by writing to the Spanish address in "For More Information” or by visiting the Spanish Social Security system's web
site at www.seg-social.es.

Under U.S. Social Security, you may earn up to four credits each year depending on the amount of your covered earnings. The

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For more information about Spain’s Social Security programs, visit any Social Security office in Spain. If you don't live in Spain, write

to:

Ministerio de Trabajo y
Asuntos Sociales
Tesoreria General de la
Seguridad Social

C/ Astros, 5 y 7

28007 Madrid

SPAIN

If you don't wish to file a claim for benefits, but would like more information about the agreement, write to:

Social Security Administration
Office of International Programs
P.O. Box 17741

Baltimore, Maryland 21235-7741
USA.

For additional information visit our website: www.socialsecurity.gov/international.

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19 if in an elementary or secondary school worker's pension is increased for each

full time) or any age if disabled before agedependent child under age 18 or disabled.

22.

SURVIVORS BENEFITS

UNITED STATES
Widow or widower-Full benefit at full
retirement age or at any age if caring for

SPAIN
Widow or widower-Full benefit at age 65
or reduced benefit at any age. The

the deceased's entitled child under age 16 deceased worker must have been

(or disabled before age 22). Reduced
benefit as early as age 60 (or age 50 if
disabled) if not caring for child. Benefits
may be continued if remarriage occurs
after age 60 (or age 50 if disabled).

Divorced widow or widower-Same as
widow or widower if marriage lasted at
least 10 years.

Children-Same as for children of retired
or disabled worker.

Other Family Members-Under certain
conditions, dependant parents age 62 or
older.

Lump-Sum Death Benefit-A one-time
payment not to exceed $255 payable on
the death of an insured worker.

How Benefits Can Be Paid

If you have Social Security credits in both the United States and Spain, you may be eligible for benefits from one or both countries.
If you meet all the basic requirements under one country’s system, you will get a regular benefit from that country. If you don't

registered with the Spanish system at the
time of death and paid contributions for
at least 500 days during the five-year
period before death, or received a
retirement or disability benefit at the time
of death.

Divorced widow or widower- Same as
widow or widower. Benefits are
proportional to time divorced widow or
widower lived with the worker.
Children-Up to age 18 or any age if
disabled. The deceased worker must have
met the same conditions as shown for
widow or widower's benefits.

Other Family Members-Dependent
parents, grandparents, brothers, sisters
and grandchildren may receive a benefit
equal to an orphan’s benefit.

Funeral Grant-One-time payment.

meet the basic requirements, the agreement may help you qualify for a benefit as explained below.

© Benefits from the U.S—If you don't have enough work credits under the U.S. system to qualify for regular benefits, you may
be able to qualify for a partial benefit from the United States based on both U.S. and Spanish credits. However, to be eligible
to have your Spanish credits counted, you must have earned at least six credits (generally one and one-half years of work)
under the U.S. system. If you already have enough credits under the U.S. system to qualify for a benefit, the United States
cannot count your Spanish credits.
Benefits from Spain—Social Security credits from both countries can also be counted, when necessary, to meet the eligibility

How Credits Get Counted

You don't have to do anything to have your credits in one country counted by the other country. If we need to count your credits
under the Spanish system to help you qualify for a U.S. benefit, we will get a copy of your Spanish record directly from Spain when

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requirements for Spanish benefits. To be eligible to have your U.S. and Spanish credits counted, you must have at least one
year of coverage credited under the Spanish system.

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amount needed to earn a work credit goes up slightly each year. For more information, see How You Earn Credits (Publication No.

05-10072).

Under the Spanish system, credits are measured in days of contributions. To simplify the information in the table, requirements are

shown in years of credit.

Monthly Benefits And Eligibility Requirements

RETIREMENT OR OLD-AGE BENEFITS

UNITED STATES

SPAIN

Worker-Full benefit at full retirement age, Worker-Full pension at age 65, or, under

or reduced benefit as early as age 62.

certain conditions, reduced pension as

Required work credits range from one andearly as age 60. Worker must have
one-half to 10 years (10 years if 62 in 1991 contributed for at least 15 years, including

or later).

at least two years during the last fifteen
years.

DISABILITY BENEFITS

UNITED STATES

SPAIN

Worker-Under full retirement age can get Worker-

benefit if unable to do any substantial
gainful work for at least a year. One and
one-half to 10 years credit

needed, depending on age at date of
‘onset. Some recent work credits also
needed unless worker is blind.

Provisional benefits-Worker needs credit
for 180 days of contributions during the
five years immediately preceding the
onset of disability. Benefits payable for up
to four and one-half years following
cessation of temporary disability (i.e., cash
sickness) benefits.

Permanent benefits-Payable if the worker's
incapacity continues beyond the period of
eligibility for provisional benefits. The
minimum contribution requirement varies
depending on the worker's age and
whether the worker was registered under
the Spanish system at the time of onset of
disability. Some recent work credits are
required. Special rules apply for young
workers.

FAMILY BENEFITS TO DEPENDENTS OF RETIRED OR DISABLED PERSONS

UNITED STATES
Spouse-Full benefit at full retirement age
or at any age if caring for the worker's
entitled child under age 16 (or disabled
before age 22). Reduced benefit as early
as age 62 if not caring for a child.
Divorced Spouse-Full benefit at full
retirement age. Reduced benefit as early
as age 62. Must be unmarried and have
been married to worker for at least
10 years.
Children-If unmarried, up to age 18 (age

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SPAIN
Spouse-No provision. However, the
worker's pension may be increased if the
worker receives a minimum benefit and
has a dependent spouse.

Divorced Spouse-No provision.

Children-No provision. However, the

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« Any Spanish Social Security office to file for Spanish benefits.

You can apply with one country and ask to have your application considered as a claim for benefits from the other country.
Information from your application will then be sent to the other country. Each country will process the claim under its own laws—
counting credits from the other country when appropriate—and notify you of its decision.

If you haven't applied for benefits before, you may need to provide certain information and documents when you apply. These
include the worker's U.S. and Spanish Social Security numbers, proof of age for all claimants, evidence of the worker's U.S. earnings
in the past 24 months and information about the worker's coverage under the Spanish system. You may wish to call the Social
Security office before you go there to see if any other information is needed.

Payment Of Benefits

Each country pays its own benefit. U.S. payments are made by the U.S. Department of Treasury each month and cover benefits for
the preceding month. Spain also pays benefits each month for the preceding month. Resident of the United States generally receive
benefits from Spain through international postal money orders.

Absence From U.S. Territory

Normally, persons who are not U.S. citizens may receive U.S. Social Security benefits while outside the U.S. only if they meet certain
requirements. Under the agreement, however, you may receive benefits as long as you reside in Spain regardless of your
nationality. If you are not a U.S. or Spanish citizen and live in another country, you may not be able to receive benefits. The
restrictions on U.S. benefits are explained in the booklet, Social Security—Your Payments While You Are Outside The United States
(Publication No. 05-10137).

Appeals

If you disagree with the decision made on your claim for benefits under the agreement, contact any U.S. or Spanish Social Security
office. The people there can tell you what you need to do to appeal the decision.

The Spanish Social Security authorities will review your appeal if it affects your rights under the Spanish system, while U.S. Social
Security authorities will review your appeal if it affects your rights under the U.S. system. Since each country’s decisions are made
independently of the other, a decision by one country on a particular issue may not always conform with the decision made by the
other country on the same issue.

For More Information

To file a claim for U.S. or Spanish benefits under the agreement, follow the instructions in "Claims For Benefits".

To find out more about U.S. Social Security benefits or for information about a claim for benefits, contact any U.S. Social Security
office. If you live outside the United States, write to:

Social Security Administration
010—Totalization

P.O. Box 17769

Baltimore, Maryland 21235-7769
U.S.A.

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Social Security

Official Social Security Website

International Programs

Totalization Agreement with Spain
SSA Publication No, 05-10188, November 2005, ICN 480192 [OMB Approval Number: 0960-0554 Expires 12/31/2016]

Contents

Introduction

Coverage and Social Security taxes

Certificate of coverage

Monthly benefits

A Spanish Pension May Affect Your U.S. Benefit
What you need to know about Medicare
Claims for benefits

For more information

Introduction

An agreement effective April 1, 1988, between the United States and Spain improves Social Security protection for people who
work or have worked in both countries. It helps many people who, without the agreement, would not be eligible for monthly
retirement, disability or survivors benefits under the Social Security system of one or both countries. It also helps people who would
otherwise have to pay Social Security taxes to both countries on the same earnings.

The agreement covers Social Security taxes (including the U.S. Medicare portion) and Social Security retirement, disability and
survivors insurance benefits. It doesn't cover benefits under the U.S. Medicare program or the Supplemental Security Income (SSI)
program.

This document covers highlights of the agreement and explains how it may help you while you work and when you apply for
benefits.

The Agreement May Help You, Your Family And Your Employer

© While you work—If your work is covered by both the U.S. and Spanish Social Security systems, you (and your employer, if
you are employed) would normally have to pay Social Security taxes to both countries for the same work. However, the
agreement eliminates this double coverage so you pay taxes to only one system (see the section on "Coverage and Social
Security taxes").

© When you apply for benefits—You may have some Social Security credits in both the U.S. and Spain but not have enough
to be eligible for benefits in one country or the other. The agreement makes it easier to qualify for benefits by letting you add
together your Social Security credits in both countries. For more details, see the section on "Monthly Benefits".

Coverage And Social Security Taxes

Before the agreement, employees, employers and self-employed persons could, under certain circumstances, be required to pay
Social Security taxes to both the United States and Spain for the same work.

Under the agreement, if you work as an employee in the United States, you normally will be covered by the United States, and you
and your employer will pay Social Security taxes only to the United States. If you work as an employee in Spain, you normally will be
covered by Spain, and you and your employer pay Social Security taxes only to Spain.

On the other hand, if your employer sends you from one country to work for that employer or an affiliate in the other country for

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you apply for benefits. If Spain needs to count your U.S. credits to help you qualify for a Spanish benefit, they will get a copy of
your U.S. record directly from the Social Security Administration when you apply for the Spanish benefit.

Although each country may count your credits in the other country, your credits are not actually transferred from one country to
the other. They remain on your record in the country where you earned them and also can be used to qualify for benefits there.

Computation Of U.S. Benefit Under The Agreement

When a U.S. benefit becomes payable as a result of counting both U.S. and Spanish Social Security credits, an initial benefit is
determined based on your U.S. earnings as if your entire career had been completed under the U.S. system. This initial benefit is
then reduced to reflect the fact that Spanish credits helped to make the benefit payable. The amount of the reduction will depend
on the number of U.S. credits: the more U.S. credits, the smaller the reduction; and the fewer U.S. credits, the larger the reduction.

A Spanish Pension May Affect Your U.S. Benefit

If you qualify for Social Security benefits from both the United States and Spain and you didn’t need the agreement to qualify for
either benefit, the amount of your U.S. benefit may be reduced. This is a result of a provision in U.S. law which can affect the way
your benefit is figured if you also receive a pension based on work that was not covered by U.S. Social Security. For more
information, call our toll-free number, 1-800-772-1213, and get the publication, Windfall Elimination Provision (Publication No. 05-
10045). If you are outside the United States, you may write to us at the address in "For More Information" section.

What You Need To Know About Medicare

Medicare is the U.S. national health insurance system for people age 65 or older or who are disabled. Medicare has two parts:
hospital insurance (also called "Part A" Medicare) and medical insurance (called “Part B" Medicare). You are eligible for free hospital
insurance at age 65 if you have worked long enough under U.S. Social Security to qualify for a retirement benefit. People born in
1929 or later need 40 credits (about 10 years of covered work) to qualify for retirement benefits.

Although the agreement between the United States and Spain allows the Social Security Administration to count your Spanish
credits to help you qualify for U.S. retirement, disability or survivor benefits, the agreement doesn’t cover Medicare benefits. As a
result, we cannot count your credits in Spain to establish entitlement to free Medicare hospital insurance.

For more information about Medicare, call our toll-free number, 1-800-772-1213, and ask for the booklet, Medicare (Publication
No. 05-10043) or visit Medicare's website at www.medicare.gov.

Claims For Benefits

If you live in the United States and wish to apply for U.S. or Spanish benefits:

¢ Visit or write any U.S. Social Security office; or
© Phone our toll-free number, 1-800-772-1213, 7 a.m. to 7 p.m. any business day. People who are deaf or hard of hearing may
call our toll-free TTY number, 1-800-325-0778.

You can apply for Spanish benefits at any U.S. Social Security office by completing an application form E/USA.
If you live in Spain and wish to apply for U.S. or Spanish benefits, contact:

© The Federal Benefits Unit at the U.S. Embassy in Madrid (phone 91-587-2261) to file for U.S. benefits; or

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Office of International Programs
P.O. Box 17741

Baltimore, Maryland 21235-7741
USA.

The request may be sent by FAX, if preferred, to (410) 966-1861. Please note this FAX number should only be used for requesting
certificates of coverage.

No special form is required to request a certificate, but, the request must be in writing and provide the following information:

© Full name of worker (including both surnames for Spanish nationals);
© Date and place of birth;

© Citizenship;

© Country of worker's permanent residence;

e US. Social Security number;

* Spanish Social Security number (if known);

© Date of hire;

© Country of hire;

© Name and address of the employer in the U.S. and Spain; and

© Date of transfer and anticipated date of return.

In addition, your employer must indicate if you remain an employee of the U.S. company while working in Spain or if you become
an employee of the U.S. company’s affiliate in Spain. If you become an employee of an affiliate, your employer must indicate if the
U.S. company has an agreement with the Internal Revenue Service under section 3121(I) of the Internal Revenue Code to pay U.S.

Social Security taxes for U.S. citizens and residents employed by the affiliate and, if yes, the effective date of the agreement.

Your employer can also request a certificate of U.S. coverage for you over the Internet using a special online request form available
at www.socialsecurity.gov/coc. Only an employer can use the online form to request a certificate of coverage. A self-employed
person must submit a request by mail or fax.

To establish your exemption from coverage under the U.S. Social Security system, your employer in Spain must request a certificate
of coverage (form E/USA 1) from the provincial office of the National Institute of Social Security in the Spanish province where the
employer is located.

The same information required for a certificate of coverage from the United States is needed to get a certificate from Spain except
that you must show your Spanish Social Security number rather than your U.S. Social Security number.

Certificates For Self-Employed Persons

If you are self-employed and would normally have to pay Social Security taxes to both the U.S. and Spanish systems, you can
establish your exemption from one of the taxes by writing to:

© If you reside in the United States, the U.S. Social Security Administration at the address in "Certificates for employees" section;
or

If you reside in Spain, the provincial office of the National Institute of Social Security in the Spanish province where you
conduct your business.

Be sure to provide the following information in your letter:

© Full name (including both surnames for Spanish nationals);
© Date and place of birth;

© Citizenship;

© Country of permanent residence;

e U.S. and/or Spanish Social Security number;

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U.S.
Sent you to work in the U.S. for more than
five years
US.
® Hired you in the US.
For a non-Spanish employer US.
For the Spanish government and you are a:
Spain
© Spanish national
U.S.
e U.S. national
You are self-employed and you:
U.S.
Reside in the U.S.
Spain

© Reside in Spain
If this table doesn't seem to describe your situation and you are:

. Write to the U.S. address in
* Working in the U.S. "Certificates for employees" section

for further information.

a Write to the Spanish address in “For
* Working in Spain more information" section for

further information.

Note

As the table indicates, a U.S. worker employed in Spain can be covered by U.S. Social Security only if he or she works for a U.S.
employer. A U.S. employer includes a corporation organized under the laws of the United States or any state, a partnership if at
least two-thirds of the partners are U.S. residents, an individual who is a resident of the U.S. or a trust if all the trustees are U.S.
residents. The term also includes a foreign affiliate of a U.S. employer if the U.S. employer has entered into an agreement with the
Internal Revenue Service under section 3121(l) of the Internal Revenue Code to pay Social Security taxes for U.S. citizens and
residents employed by the affiliate.

Certificate Of Coverage

A certificate of coverage issued by one country serves as proof of exemption from Social Security taxes on the same earnings in the
other country.

Certificates For Employees

To establish an exemption from compulsory coverage and taxes under the Spanish system, your employer must request a
certificate of coverage (form USA/E 1) from the U.S. at this address:

Social Security Administration

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five years or less, you will continue to be covered by your home country and you will be exempt from coverage in the other
country. For example, if a U.S. company sends an employee to work for that employer or an affiliate in Spain for no more than five
years, the employer and the employee will continue to pay only U.S. Social Security taxes and will not have to pay in Spain.

If you are self-employed and reside in the United States or Spain, you generally will be covered and taxed only by the country
where you reside.

Note

In addition to retirement, survivors and disability benefits, Spanish Social Security taxes cover several other programs including
short-term sickness benefits, health insurance, unemployment benefits, workers’ compensation and family allowances. As a result,
workers exempted from Spanish Social Security coverage by the agreement pay no Social Security taxes for these programs and
generally cannot receive benefits from them. If the agreement exempts you from Spanish coverage, you and your employer may
wish to arrange for alternative benefit protection.

Summary Of Agreement Rules

The following table shows whether your work is covered under the U.S. or Spanish Social Security system. If you are covered under
U.S. Social Security, you and your employer (if you are an employee) must pay U.S. Social Security taxes. If you are covered under
the Spanish system, you and your employer (if you are an employee) must pay Spanish Social Security taxes. "Certificate of
coverage" section explains how to get a form from the country where you are covered that will prove you are exempt in the other
country.

Your Work Status Coverage And Taxes
You are working in Spain:

For a U.S. employer who:

US.
® Sent you to work in Spain for five years or
less
Spain
© Sent you to work in Spain for more than
five years
Spain
© Hired you in Spain
For a non-U.S. employer Spain

For the U.S. government and you are a:
USS. (either Social Security or federal

* US. national retirement program

Spain
© Spanish national
You are working in the United States:
For an employer in Spain who:
Spain
© Sent you to work in the U.S. for five years
or less

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