BASIC (07-14)

A. Forms to complete for Slovak benefits

Along with the Form SSA-2490-BK (Application for Benefits under a U.S. International Agreement), an applicant for Slovak benefits must complete a special Slovak application form.

B. Application process for Slovak benefits

The special Slovak application is Form SK/USA 2 (Claim for Pension Benefits from the Pension Insurance System of the Slovak Republic).

The bilingual Slovak application form is available through the Slovak Republic Social Insurance Agency website.

C. Procedure for filing an application for Slovak benefits

1. Applicant brings the special Form SK/USA 2 to file for Slovak benefits

If an applicant wishes to file for Slovak benefits and brings the special form (SK/USA 2) for Slovak benefits to the FO:

• accept, date and location stamp the application.

• photocopy and certify the photocopied application.

• photocopy and certify the photocopies of any additional documents (evidence) the Slovak agency requested that the applicant included with the Slovak claim.

• request an “Informational/Certified Earnings Record” (ICERS) per MSOM ICERS 001.004, and send the ICERS and the original SSA date and location-stamped Slovak application and any additional SSA-certified claims material (photocopies of evidence) to the Office of Earnings and International Operations (OEIO)/Division of International Operations (DIO) in Baltimore at the following address:

  OEIO/DIO
  P.O. Box 17769
  Baltimore, Maryland 21235-7769

• complete the Modernized Development Worksheet (MDW) screen to show the date the FO sent the Slovak claim to OEIO/DIO.

• show “Totalization” as the ISSUE when completing the MDW screen.

• return to the claimant the photocopy of the SK/USA 2 and any original evidentiary documents submitted by the claimant

Once OEIO/DIO receives the claim, they will send the claim directly to the Slovak agency along with the evidence and the worker’s U.S. coverage record.

2. Applicant brings the special Form SK/USA 2 to file for Slovak benefits

If an applicant wishes to file for Slovak benefits and does not bring the special form for Slovak benefits (SK/USA 2) to the FO:

• obtain a copy of Form SK/USA 2 from the Social Insurance Agency website.

• print Form SK/USA2 and instructions and give to the applicant to complete;

• provide assistance in completing the Form SK/USA 2;

  NOTE: Most applicants filing for Slovak benefits should be able to complete the application without assistance by using the instructions provided with the application.

• witness the applicant signature on the form.

• accept, date and location stamp the application.

• photocopy and certify the photocopied application.

• request an “Informational/Certified Earnings Record” (ICERS) per MSOM ICERS 001.004.

• photocopy and certify the photocopies of any documents (evidence) the Slovak agency has requested that the applicant include with the Slovak claim.

• send the ICERS and the original SSA date and location-stamped Slovak application and any additional SSA-certified claims material (photocopies of evidence) to the Office of Earnings and International Operations (OEIO)/Division of International Operations (DIO) in Baltimore at the following address:

  Social Security Administration
  OEIO/DIO
  P.O. Box 17769
  Baltimore, Maryland 21235-7769

• complete the Modernized Development Worksheet (MDW) screen to show the date the FO sent the claim for Slovak benefits to OEIO/DIO.

• show “Totalization” as the ISSUE when completing the MDW screen.

• return to the claimant the photocopy of the Form SK/USA 2 and any original evidentiary documents submitted by the claimant.

Once OEIO/DIO receives the claim, OEIO/DIO will send the claim directly to the Slovak agency along with the evidence and the worker’s U.S. coverage record.

D. References

• GN 00301.105 Certification of Evidence for Totalization Claims

• GN 01753.225 Requests for Status of Applications for Slovak Benefits