The Application For Benefits Under A U.S. International Social Security Agreement
(Form SSA-2490-BK) is an application for benefits under any U.S. Social Security agreement.
It is a multi-purpose form which an applicant may use, depending on the circumstances,
to claim Totalization benefits from the United States, regular or Totalization foreign
benefits from the other country, or both U.S. and foreign benefits.
The chart in GN 01702.120 shows which parts of the SSA-2490-BK the applicant must complete to claim U.S. and/or
foreign benefits under each agreement.
Take the SSA-2490 on the modernized claims system (MCS) if the number holder (NH)
is filing for both U.S. (regular or Totalization) and foreign life benefits. The SSA-2490
is not available on MCS when the applicant is filing for foreign benefits only or
for survivor benefits (either U.S. or foreign). In those cases, use a paper or electronic
(e-form) SSA-2490-BK. (An SSA-2490-BK is not necessary in claims for U.S. auxiliary
benefits in life cases since the number holder (NH) will have completed it previously
in connection with his or her claim.) Form SSA-2490-BK is also available through Totalization
Benefits Kit on the Intranet here.
NOTE: The paper or electronic (e-form) Form SSA-2490-BK is printed only in English, and
is used only in SSA field offices and U.S. foreign service posts. Foreign social insurance
agencies use different application forms to take claims for benefits under an agreement
from foreign residents.