BASIC (07-14)

GN 01753.215 Applications for Benefits Under the Agreement with the Slovak Republic

A. Filing for U.S. Totalization benefits

An applicant filing for benefits under the agreement with the Slovak Republic 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, the Slovak Republic only, or from both countries.

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

1. When you can use the MCS SSA-2490-BK

The SSA-2490-BK is available through MCS. Use the MCS version only when the number holder (NH) is filing 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 Slovak benefits.

2. When you cannot use the MCS SSA-2490-BK

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

  • Slovak benefits only; or

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

    NOTE: Use a paper or electronic (eform) SSA-2490-BK application form for Totalization survivor claims.

For instructions on how to complete the SSA-2490-BK, see GN 01702.110.

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

C. Determining the required application screens on MCS for Totalization benefits

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

1. U.S. Totalization benefits only

a. Retirement and disability claims

Complete the following in retirement or disability claims:

  • MCS application screens;

  • Totalization (TOTL) screen (You can view this screen in MSOM MCS 009.011); and

  • SSA-2490-BK screens (You can view this screen in MSOM MCS 007.001).

b. Survivors claims

Complete the following in survivors 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. Slovak benefits only (regular or Totalization)

Claims for Slovak 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. Slovak 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-BK screens (