TN 1 (06-14)

GN 01739.215 Application for Benefits under the Agreement

A. Filing for U.S. totalization benefits

An applicant filing for benefits must complete Form SSA-2490-BK (Application for Benefits under a U.S. International Social Security Agreement). The applicant must complete this form whether the application is for benefits from the United States only, Chile only, or from both countries.

B. Using the SSA-2490-BK (Application for Benefits under a U.S. International Social Security Agreement) Modernized Claims Systems (MCS) version

1. When to use the MCS version

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

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

  • Concurrent claim for U.S. retirement or disability benefits (regular or totalization) and Chilean benefits.

2. When you cannot use the MCS version

Do not use the MCS version of the SSA-2490-BK when the applicant is filing for:

  • Chilean benefits only; or

  • U.S. or Chilean survivor’s benefits.

Use a paper or electronic (eform) SSA-2490-BK application form for totalization survivor claims. Do not use the MCS version. For instructions to complete the SSA-2490-BK, see GN 01702.110.

NOTE: If there is a previous totalization life claim award, do not take an SSA-2490-BK for U.S. auxiliary benefits or survivor claims.

C. Determining which application screens to use on MCS for totalization benefits

Use the following information to determine the application screens to complete when taking claims for U.S. Totalization benefits or Chilean benefits under the agreement with Chile.

1. U.S. totalization benefits only

a. Retirement or disability claims

Complete the following for retirement or disability claims:

  • MCS application screens;

  • Totalization (TOTL) screen (see MSOM MCS 009.011); and

  • SSA-2490 screens (see MSOM MCS 007.001).

b. Survivors claims

Complete the following for survivor’s claims:

  • MCS application screens;

  • Totalization (TOTL) screen (see MSOM MCS 009.011); and

  • Part I of the paper or electronic (eform) application Form SSA-2490-BK.

2. Chilean benefits only (regular or totalization)

Claims for Chilean benefits only (regular or totalization) are MCS exclusions. Complete Parts I and II of the paper or electronic (eform) application Form SSA-2490-BK.

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

a. Retirement or disability claims

In retirement or disability claims, complete the following:

  • MCS application screens;

  • TOTALIZATION (TOTL) screen (see MSOM MCS 009.011); and

  • SSA-2490 screens (see MSOM MCS 007.001).

b. Survivors claims

In survivors claims, complete the following:

  • MCS application screens:

  • TOTALIZATION (TOTL) screen (see MSOM MCS 009.011), and

  • Parts I and II of the paper or electronic (eform) application Form SSA-2490-BK.

D. Procedure for entering Chilean insurance numbers

Enter the worker's and each claimant's National Identification Number (RUT) on all claims. Also, enter any other social insurance number for a worker who contributed to the old system.

In Part I of the SSA-2490-BK, enter all of the following information if the RUT is unknown. The Chilean agencies need this information to complete the NH's Chilean coverage record.

  • the worker's full name, including both the paternal and maternal last names (see GN 00307.160);

  • the worker's employment history, including names of employers and dates of employment; and

  • the name of the agency or Pension Fund Administrator to which the worker last contributed.

NOTE: In 1980, Chile began to issue a National Personal Identification Number, known by the Spanish acronym RUT, to all Chilean residents. This is a 9-digit number (eight numbers followed by a dash and a number or the letter K). Under the social insurance system, the wage earner's program provided the worker with a social insurance number.