Effective Dates: 10/18/2022 - Present Previous | Next

TN 3 (10-22)

GN 01751.215 Application for Benefits under the Polish Agreement

A. Policy — Applications for benefits under the Polish agreement

An individual filing for benefits under the agreement with Poland 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 Poland, or from both countries.

B. Applications for Polish benefits may be filed 1 month in advance of the entitlement date.

1. When the Modernized Claims System (MCS) Version May Be Used

The SSA-2490-BK is available through MCS, but the MCS version may be used only when the number holder (NH) is filing for:

  • •

    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 Polish benefits.

2. When the MCS Version May Not Be Used

The MCS version of the SSA-2490-BK may not be used to file for:

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    Polish benefits only, or

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    U.S. or Polish survivor’s benefits.

A paper or electronic (e-form) SSA-2490 application form must be used in these cases. Form SSA-2490-BK is also available through the Totalization Benefits Resource Kit.

NOTE: It is not necessary to take an SSA-2490-BK in claims for U.S. auxiliary benefits in life cases or in survivor cases where there was a previously approved award in a life case since this application would have been completed previously in connection with the NH’s claim.

C. Procedure — Required applications under the Polish agreement

Use the following information to determine which applications must be completed when taking claims for U.S. Totalization benefits and/or Polish benefits under the agreement with Poland.

1. U.S. Totalization Benefits Only

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    Retirement or disability claims under U.S. Totalization benefits

    In retirement or disability claims, complete the appropriate retirement or disability MCS application screens, the TOTALIZATION (TOTL) screen (see MSOM MCS 009.011), and the SSA-2490-BK screens (see MSOM MCS 007.001).

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    Survivor claims under U.S. Totalization benefits

    In survivor claims, complete the appropriate MCS application screens, the TOTALIZATION (TOTL) screen (see MSOM MCS 009.011), and Part I of the paper or electronic (e-form) application Form SSA-2490-BK.

2. Polish Benefits Only (Regular or Totalization)

Claims for Polish benefits only (regular or Totalization) are MCS exclusions. Complete Parts I and II of the paper or electronic (e-form application Form SSA-2490-BK.

3. Polish Benefits (regular or Totalization) and U.S. Benefits (regular or Totalization)

  • •

    Retirement or disability claims

    In retirement or disability claims, complete the appropriate retirement or disability benefits MCS application screens, the TOTALIZATION (TOTL) screen (see MSOM MCS 009.011), and the SSA-2490 screens (see MSOM MCS 007.001).

  • •

    Survivor Claims (regular or Totalization)

    In survivor claims, complete the appropriate MCS application screens, the TOTALIZATION (TOTL) screen (see MSOM MCS 009.011), and Parts I and II of the paper or electronic (e-form) application form SSA-2490.

NOTE: Form SSA-2490-BK is available through the Totalization Benefits Resource Kit.

D. Procedure — Required Remarks on the Totalization remarks screen (FRMK)

1. Coverage under the Polish Zaklad Ubezpieczen Spolecznych-ZUS

In all claims for Polish benefits, ask the applicant if the applicant has worked in Poland and if they are applying for the ZUS pension. The response to this question should be entered on the Totalization Remarks (FRMK) screen in MCS (see MSOM MCS 007.009) or in the “Remarks” section (#19) on the paper or electronic (e-form) application form SSA-2490.

2. Coverage under the Polish Kasa Rolniczego Ubezpiecenia Spolecznego- KRUS

In all claims for Polish benefits, ask the applicant if the applicant has worked on a farm in Poland and if they are applying for the KRUS pension. The response to this question should be entered on the Totalization Remarks (FRMK) screen in MCS (see MSOM MCS 007.009) or in the “Remarks” section (#19) on the paper or electronic (e-form) application form SSA-2490.

E. References

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    MSOM MCS 007.001, Introduction to SSA-2490 - Overview

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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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    MSOM MCS 009.011, Totalization (TOTL)

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

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201751215
GN 01751.215 - Application for Benefits under the Polish Agreement - 10/18/2022
Batch run: 10/18/2022
Rev:10/18/2022