TN 2 (05-11)

GN 01733.215 Application for Benefits under the Luxembourg Agreement

A. Filing for benefits

An applicant who wishes to file for benefits under the agreement with Luxembourg 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.

NOTE: Accept applications for Luxembourg benefits up to one year in advance of the entitlement date.

Accept applications for U.S benefits up to four months in advance of the entitlement date.

Follow GN 00204.007C when an application for U.S. benefits is filed more than four months in advance of the entitlement date.

B. Using the SSA-2490-BK Modernized Claims System (MCS) version

1. When the MCS version may be used

The SSA-2490-BK is available through MCS. Use the MCS version only when the number holder (NH) is filing for one of the benefits listed below.

  • U.S. retirement or disability totalization benefits only, or

  • U.S. retirement or disability benefits (regular or totalization) and concurrently for Luxembourg benefits.

2. When the MCS version may not be used

Do not use the MCS version of the SSA-2490-BK to file an application for either:

  • Luxembourg benefits only, or

  • U.S. or Luxembourg survivor benefits.

Use a paper or electronic (e-form) SSA-2490-BK application form in these cases. For instructions to complete the SSA-2490-BK, see GN 01702.110.

NOTE: Do not 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. The number holder (NH) previously completed one in connection with his or her claim.

C. Determining which application screens are required on MCS

Use the following information to decide which application screens you need when taking claims for U.S. totalization benefits, Luxembourg benefits, or both under the agreement with Luxembourg.

1. U.S. totalization benefits only

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

  • 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) form SSA-2490-BK.

2. Luxembourg benefits only (regular or totalization)

Complete both parts of the two-part SSA-2490BK using either the paper or electronic (eForm) version of the application form since claims for Luxembourg benefits only (regular or totalization) are MCS exclusions.

3. Luxembourg benefits (regular or totalization) and U.S. benefits (regular or totalization)

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

  • In survivors claims, complete the appropriate MCS application screens, the totalization (TOTL) screen (see MSOM MCS 009.011), and both parts of the two-part paper or electronic (e-form) version of the application form SSA-2490-BK.

D. Entering required remarks

Enter the maiden name of a married woman (the worker or the claimant) in the remarks section of form SSA-2490-BK.

E. References

  • Introduction to SSA-2490 – Overview, MSOM MCS 007.001

  • Totalization (TOTL), MSOM MCS 009.011

  • Application for Benefits under a U.S. International Social Security (Totalization) Agreement (Form SSA-2490-BK), GN 01702.110

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


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201733215