Prepare initial claims packages to request Chilean coverage records and to inform
the Chilean agencies about claims for Chilean benefits. (See GN 01739.205 – GN 01739.220 for the applications and evidence required in the packages.)
Prepare a claims package that includes:
Form SSA-2960-CHI to request a Chilean coverage record, and
The first page of Form SSA-2490-BK to provide the Chilean work history.
Form SSA-2960-CHI. Request a Chilean coverage record, if one is needed.
The first page of Form SSA-2490-BK (Work History)
U.S. totalization earnings record
Medical evidence from SSA's files, if the Chilean claim is for disability benefits.
Also include a copy of Form SSA-831 to provide the U.S. disability decision if a decision
has been made.
Note: SSA files include claims folders in DIO, a PSC, a FO, OCO's Megasite or the caves
in Kansas City. However, it does not include folders in ODAR.
Evidence submitted for the Chilean claim
A request for the Chilean coverage record, if one is needed.
Applications and Evidence for Chilean Agreement, GN 01739.205 – GN 01739.220