TN 3 (01-03)

A. Policy

An individual who wishes to file for benefits under the agreement with Belgium must complete Form SSA-2490-BK (Application For Benefits Under A U.S. International Social Security Agreement). This is true whether the applicant is filing for benefits only from the United States, only from Belgium or from both countries.

B. Process

1. When the Modernized Claim System (MCS) Version May Be Used

The SSA-2490-BK is available through the modernized claims systems (MCS), but the MCS version may only be used when the number holder (NH) is filing for:

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

• U.S. retirement or disability benefits (regular or Totalization) and concurrently for Belgian benefits.

2. When the MCS Version May Not Be Used

The MCS version of the SSA-2490-BK may not be used to file for:

• Belgian benefits only, or

• U.S. or Belgian survivors benefits.

A paper or electronic (e-form) SSA-2490-BK application form must be used in these cases. Form SSA-2490-BK is also available through the Totalization Benefits Resource Kit on the Intranet here.

NOTE: It is not necessary to take an SSA-2490-BK in claims for U.S. auxiliary benefits in life cases or in survivor cases where there was a previously approved award in a life case since this application would have been completed previously in connection with the NH's claim.

C. Procedure — Required applications

Use the following information to determine which applications must be completed when taking claims for U.S. Totalization benefits and/or Belgian benefits under the agreement with Belgium.

1. U.S. Totalization Benefits Only

a. Retirement or Disability Claims

In retirement or disability claims, complete the appropriate retirement or disability benefit MCS application screens, the TOTALIZATION (TOTL) screen (see MSOM MCS 009.011 ), and the SSA-2490 screens (see MSOM MCS 007.001 ).

b. Survivors Claims

In survivors claims, complete the appropriate MCS application screens, the TOTALIZATION (TOTL) screen (see MSOM MCS 009.011 ), and Part I of the paper or electronic (e-form) application Form SSA-2490-BK.

2. Belgian Benefits Only (Regular or Totalization)

Claims for Belgian benefits only (regular or Totalization) are MCS exclusions. Complete Parts I and II of the paper or electronic (e-form) application Form SSA-2490-BK.

3. Belgian Benefits (Regular or Totalization) and U.S. (Regular or Totalization) Benefits

a. Retirement or disability claims

In retirement or disability claims, complete the appropriate retirement or disability benefit MCS application screens, the TOTALIZATION (TOTL) screen (see MSOM MCS 009.011 ), and the SSA-2490 screens (see MSOM MCS 007.001 ).

b. Survivors claims

In survivors claims, complete the appropriate MCS application screens, the TOTALIZATION (TOTL) screen (see MSOM MCS 009.011 ), and Parts I and II of the paper or electronic (e-form) application Form SSA-2490-BK.

NOTE: Form SSA-2490-BK is available through the Totalization Benefits Resource Kit on the Intranet here.

D. References

• Completing the SSA-2490 on MCS, MSOM MCS 007.001

• Completing the paper or electronic (e-form) Form SSA-2490-BK,

• Totalization requirements, MSOM MCS 009.011

• Forwarding foreign application to the Office of International Operations, GN 01702.325