1. Totalization benefits only - Form SSA-2490-BK

When an applicant files for U.S. Totalization benefits under the U.S. - U.K. Agreement, the field office (FO) must complete Part I and Part II of Form SSA-2490-BK (Application For Benefits Under A U.S. International Social Security Agreement) using the appropriate Modernized Claim System (MCS) screens. The FO must also complete the appropriate retirement, survivors, or disability insurance application(s).

2. U.S. Totalization and U.K. benefits - Special U.K. application form

An individual who wishes to file for both U.S. Totalization benefits and U.K. benefits must complete Part I and Part II of Form SSA-2490-BK, the appropriate retirement, survivors or disability insurance application(s) and Form SSA-1278 (Request for Payment of Reimbursable Expenses under the U.S.A. - United Kingdom Agreement on Social Security).

You can access the special U.K. form in the Totalization Benefits Resource Kit online.

1. When to use the MCS version

Form SSA-2490-BK is available through MCS. Use the MCS version only when the NH is filing for:

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  U.S. retirement or disability Totalization benefits only; or

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  U.S. retirement or disability benefits (regular or Totalization) and concurrently for U.K. benefits.

2. When not to use the MCS version

Do not use the MCS version of the Form SSA-2490-BK when the applicant is filing for:

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  U.K. benefits only; or

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  U.S. or U.K. survivors benefits.

Use the paper or electronic Form SSA-2490-BK for Totalization survivor claims. For instructions on how to complete the SSA-2490-BK, see GN 01702.110.

If there is an existing U.S. Totalization life claim award, do not take an SSA-2490-BK in claims for U.S. auxiliary benefits or survivor claims.

Use the following information to determine which application screens to complete when taking claims for U.S. Totalization benefits under the agreement with the U.K.

1. Retirement or disability claims

In retirement or disability claims, complete the appropriate retirement or disability benefit MCS application screens, the TOTALIZATION (TOTL) screen (see MS 03509.011), and the SSA-2490 screens (see MS 03507.001).

2. Survivors claims

In survivors claims, complete the appropriate MCS application screens, the TOTALIZATION (TOTL) screen (see MS 03509.011), and Part I and Part II of the paper or electronic Form SSA-2490-BK.

1. The application process

Along with the Form SSA-2490-BK, an applicant for U.K. benefits must complete one or more special U.K. application forms. The form(s) required vary depending on the type of benefit claimed.

FOs do not take the special U.K. application forms. After receiving an application for U.K. benefits filed with SSA, the U.K. agency mails the appropriate U.K. application forms directly to the applicant. The U.K. agency instructs the applicant to complete the forms and mail them directly to the U.K. agency with any required evidence needed in the application process.

2. Applicant brings U.K. special application forms to the FO

If an applicant brings any U.K. application forms to the FO, the FO should:

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  Accept, photocopy, and certify the photocopied application; and

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  Photocopy and certify any additional documents (evidence) the U.K. agency requested the applicant to include with the U.K. claim; and

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  Request an "Informational/Certified Earnings Record" (ICERS) as described in MS ICERS 02101.004; and

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  Return to the applicant any original evidence documents and the certified photocopy of the application; and

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  Send the original U.K application and any certified photocopies or additional claims material to the Office of Earnings and International Operations (OEIO), Division of International Operations (DIO) in Baltimore at the following address:

  Social Security Administration

  OEIO - DIO

  P.O. Box 17769

  Baltimore, Maryland 21235-7769

  FAX number: 410-966-1861

  NOTE: If a courier service is used, mail to:

  Social Security Administration

  Division if International Operations

  6100 Wabash Avenue

  Baltimore, Maryland 21215

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  GN 01702.110, Application for Benefits Under a U.S. International Social Security (Totalization) Agreement (Form SSA-2490-BK)

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  GN 01702.310, Routing of Claims for U.S. Benefits Involving Totalization

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  GN 01702.315, Processing Totalization Insured - Status Notices in Claims for U.S. Benefits

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  MS 03507.001, Introduction to SSA-2490 - Overview

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  MS 03509.011, Totalization (TOTL)