BASIC (08-94)

GN 01726.330 Information About Dutch Application Forms NL/VS 202 and NL/VS 203

A. Background

SVB has designed two application forms for Dutch benefits under the agreement. These forms are the NL/VS 202 (for old age claims) and the NL/VS 203 (for survivors' claims). SSA has no role in the taking, supplying or forwarding of these forms. However, SVB often includes these forms, completed by the claimant, in their claims packages.

B. Policy

  • Both forms contain space for the worker or survivor claimant to list the worker's periods of residence and employment from age 15 to the present. An indication in this space that the worker was employed in the U.S. constitutes protective filing for U.S. benefits and must be developed or closed out, as appropriate, by a CA. However, an indication that the worker merely resided in the U.S. does not constitute protective filing under the agreement since coverage under the U.S. system is not residence based like it is in the Netherlands.

  • Both forms also contain a statement authorizing SSA to release information to SVB. Thus in the absence of an application form SSA-2490 or SVB's statement on their liaison form that there is a claim under the agreement, the NL/VS 202 or NL/VS 203 constitutes the claimant's authorization to disclose if it is properly signed by the claimant.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201726330
GN 01726.330 - Information About Dutch Application Forms NL/VS 202 and NL/VS 203 - 04/09/2014
Batch run: 04/09/2014
Rev:04/09/2014