We will use the information you provide to determine potential eligibility for receiving benefits under an international agreement on social security or to determine if we need additional information to support any claims.

The Application For Benefits Under A U.S. International Social Security Agreement (Form SSA-2490-BK) is an application for benefits under any U.S. Social Security Agreement.

An applicant filing for benefits 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, Chile only, or from both countries.

Complete SSA-2490-BK (Application for Benefits Under a U.S. International Social Security Agreement) and mail to your local Social Security Administration office.

Form SSA-2490-BK (Application for Benefits under a U.S. International Social Security Agreement) is available through MCS. The MCS version of Form SSA-2490-BK is an option for filing only when the number holder (NH) is filing for: U.S. retirement or disability benefits (regular or Totalization) and concurrently for Swiss benefits. 2.

Purpose: The information on this form is needed to enable Social Security authorities in the U.S. and the foreign country you listed on page 3 of this application to determine if you are entitled to benefits under an international agreement on social security.

To the Social Security Agency of a foreign country, to carry out the purpose of an international Social Security agreement entered into between the United States and the other country, pursuant to section 233 of the Social Security Act.

SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA's website at www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

GN 01702.120 Summary of Required Application Forms for U.S. Or Foreign Benefits Under a Totalization Agreement. The application form (s) that an applicant must file will vary depending …