An applicant for Uruguayan benefits must complete one or more special Uruguayan application forms, in addition to Form SSA-2490-BK (Application for Benefits under a U.S. International Social Security Agreement). The form(s) will vary depending on the type of benefit.

The Social Security Administration (SSA) field offices (FO) will provide the applicant with the special Uruguayan Application Form (UY-US/01) but will not assist the applicant with completing the form. After receiving a claim for Uruguayan benefits filed with SSA, the Uruguayan agency will contact the applicant directly if necessary to provide instructions for the applicant to complete and mail any other form(s) directly to the Uruguayan agency along with any additional required evidence.

If an applicant wishes to file for Uruguayan benefits and brings the Uruguayan Application Form UY-US/01 to the FO, take the following actions:

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  accept, photocopy and certify the application.

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  photocopy and certify any additional documents (evidence) the Uruguayan agency requested that the applicant include with the Uruguayan claim.

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  request an "Informational/Certified Earnings Record" (ICERS) as described in

  MS ICERS 2101.004.

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  send the Uruguayan application and any additional claims material to the Division of International Operations (DIO) in Baltimore at the following address:

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  complete the Modernized Development Worksheet (MDW) screen to show the date the FO sent the Uruguayan claim to DIO. Show "Totalization" as the ISSUE.

Once DIO receives the claim, they will send the claim directly to the Uruguayan agency along with the evidence and the worker’s U.S. coverage record. DIO will annotate the MDW to show the type of claim and the date they forwarded the claim to the Uruguayan agency.

For instructions on how to accept the claim for benefits if an applicant wishes to file for Uruguayan benefits and does not bring the Uruguayan special forms, see GN 01760.215.

MS ICERS 02101.004 Informational/Certified Earnings Records – Totalization (ICIC)

GN 01760.215 Applications for Benefits under the Agreement with Uruguay