TN 2 (05-11)
GN 01733.220 Additional Applications for Luxembourg Benefits
A. Forms to complete
Along with the form SSA-2490-BK, an applicant for Luxembourg benefits must complete one or more special Luxembourg application forms. The form(s) required vary depending on the type of benefit claimed.
B. Application process
Field offices (FOs) do not take the special Luxembourg application forms. After receiving a claim for Luxembourg benefits filed with SSA, the Luxembourg agency mails the appropriate Luxembourg application forms to the applicant. The Luxembourg agency instructs the applicant to complete the forms and mail them directly to the Luxembourg agency with any evidence needed.
C. Procedure for filing an application
If an applicant brings one of the Luxembourg application forms to the FO, the FO should:
provide assistance in completing the form(s),
photocopy and certify documents (evidence) the Luxembourg agency requested the applicant to include with the Luxembourg claim, and
return the form(s), certified photocopies to the applicant, and tell him or her to mail them directly to the Luxembourg agency that sent them.
REMINDER: Do not mail the Luxembourg application forms to the Office of International Operations (OIO).