An applicant filing for benefits under the U.S. - Luxembourg Agreement must complete
Form SSA-2490-BK Application for Benefits under a U.S. International Social Security
Agreement. This is true whether the applicant is filing for benefits only from the United States,
only from Luxembourg, or from both countries.
It is necessary to complete the Form SSA-2490-BK if the applicant is filing for any
benefits under the Agreement: this could include benefits only from the United States,
benefits only from Luxembourg, or benefits from both countries.
An applicant who is filing for Luxembourg benefits only, and NOT for benefits under
the Agreement must complete a Luxembourg application, and does not need to complete
Form SSA-2490-BK.