Application for Benefits Under a U.S. International Social Security Agreement

When SSA enters into international Social Security agreements between the United States and foreign countries, applicants can file for benefits from one country, and that application can constitute an application for benefits from the other country, provided the applicants express the intent to claim benefits from the other country at the time of the initial application. SSA refers to these agreements as Totalization agreements. Under these agreements, we may base benefits on combined periods of coverage from the two agreement countries. SSA uses the information from the SSA-2490-BK to determine entitlement to Social Security benefits from the United States or from a country that has entered into a Social Security agreement with the United States. The respondents are individuals who are applying for old-age, survivors or disability benefits from the U.S. or from a Totalization agreement country. In this Change Request we are expanding the burden to include the agreement with Romania.

The latest form for Application for Benefits Under a U.S. International Social Security Agreement expires 2027-07-31 and is listed under ICR 202606-0960-008.

Application for Benefits Under a U.S. International Social Security Agreement (Paper)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.