TN 5 (05-23)

GN 01753.220 Additional Applications for Benefits Under the Agreement with the Slovak Republic

A. Forms to complete for Slovak benefits

Along with the Form SSA-2490-BK (Application for Benefits under a U.S. International Agreement), an applicant for Slovak benefits must complete a special Slovak application Form.

B. Application process for Slovak benefits

The special Slovak application is Form SK/USA 2 (Claim for Pension Benefits from the Pension Insurance System of the Slovak Republic).

The bilingual Slovak special application Form SK/USA 2 is available on the Division of International Operations (DIO) Totalization Forms Intranet website.

NOTE: Do not share this Form publicly unless claimants are filling an application or claiming benefits.

C. Procedure for filing an application for Slovak benefits

1. If the applicant brings the special Form SK/USA 2 to file for Slovak benefits

If an applicant wishes to file for Slovak benefits and brings the special Form (SK/USA 2) for Slovak benefits to the FO:

  • Accept, date and location stamp the application; and

  • Photocopy and certify the photocopied application; and

  • Photocopy and certify the photocopies of any additional documents (evidence) the Slovak agency requested that the applicant included with the Slovak claim; and

  • Request an “Informational/Certified Earnings Record” (ICERS) per MSOM ICERS 001.004, and send the ICERS and the original SSA date and location-stamped Slovak application and any additional SSA-certified claims material (photocopies of evidence) to the Division of International Operations (DIO) at the following address:

    Social Security Administration
    Division of International Operations

    P.O. Box 17769

    Baltimore, Maryland 21235-7769

  • Complete the Modernized Development Worksheet (MDW) screen to show the date the FO sent the Slovak claim to OEIO/DIO; and

  • Show “Totalization” as the ISSUE when completing the MDW screen; and

  • Return to the claimant the photocopy of the SK/USA 2 and any original evidentiary documents submitted by the claimant.

Once OEIO/DIO receives the claim, they will send the claim directly to the Slovak agency along with the evidence and the worker’s U.S. coverage record.

2. If the applicant does not bring the special Form SK/USA 2 to file for Slovak benefits

If an applicant wishes to file for Slovak benefits and does not bring the special Form for Slovak benefits (SK/USA 2) to the FO:

  • Obtain a copy of Form SK/USA 2 from the Division of International Operations (DIO) Totalization Forms Intranet website; and

  • Print Form SK/USA2 and instructions and give to the applicant to complete; and

  • Provide assistance in completing the Form SK/USA 2; and

    NOTE: Most applicants filing for Slovak benefits should be able to complete the application without assistance by using the instructions provided with the application.

  • Witness the applicant signature on the Form; and

  • Accept, date and location stamp the application; and

  • Photocopy and certify the photocopied application; and

  • Request an “Informational/Certified Earnings Record” (ICERS) per MSOM ICERS 001.004; and

  • Photocopy and certify the photocopies of any documents (evidence) the Slovak agency has requested that the applicant include with the Slovak claim; and

  • Send the ICERS and the original SSA date and location-stamped Slovak application and any additional SSA-certified claims material (photocopies of evidence) to the Division of International Operations (DIO) at the following address:

    Social Security Administration

    Division of International Operations

    P.O. Box 17769

    Baltimore, Maryland 21235-7769

  • Complete the Modernized Development Worksheet (MDW) screen to show the date the FO sent the claim for Slovak benefits to OEIO/DIO; and

  • Show “Totalization” as the ISSUE when completing the MDW screen; and

  • Return to the claimant the photocopy of the Form SK/USA 2 and any original evidentiary documents submitted by the claimant.

Once OEIO/DIO receives the claim, OEIO/DIO will send the claim directly to the Slovak agency along with the evidence and the worker’s U.S. coverage record.

D. References

  • GN 00301.105, Certification of Evidence for Totalization Claims.

  • GN 01753.225, Requests for Status of Applications for Slovak Benefits.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201753220
GN 01753.220 - Additional Applications for Benefits Under the Agreement with the Slovak Republic - 05/16/2023
Batch run: 05/16/2023
Rev:05/16/2023