3) Type of Industry self-employment activity or business (4) Social Insurance (5) Name of Agency to which Number used contributions paid while working (b) Use columns (1) - (4) to enter information about the worker's periods of coverage under the foreign social insurance system which are not based on employment or self-employment (e.g., coverage for voluntary contributions, deemed or equivalent coverage, periods of military service, illness, etc.) (1) Dates Covered (From - To) (2) Type of cov.
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How to fill out the SSA-2490-BK online
The SSA-2490-BK form is an application for benefits under a U.S. international social security agreement. This guide offers step-by-step instructions to help you accurately complete the form online, ensuring a smooth application process.
Follow the steps to fill out the SSA-2490-BK online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Part I, enter the worker's full name and social security number in the designated fields (1a and 1b).
- Provide information about the worker's social security credits and last place of residence in the foreign country. Use the specified columns to detail periods of employment or self-employment in the foreign country (2a).
- Continue by detailing periods of coverage under the foreign social insurance system (2b) and entering the worker's last place of residence in the foreign country (2c).
- In item 3, indicate all benefits for which you are eligible under the agreement by specifying the name of the foreign country.
- In item 4, check the relevant boxes to indicate the type of benefits being claimed from both the foreign country and the United States.
- Complete details about the worker in item 5, including name at birth, sex, social insurance number in the foreign country, and parents' names if necessary.
- Item 6 requires checking if you want to protect an eligible spouse's and/or child's right to benefits.
- If applicable, complete items 7 through 10 regarding the worker's military service, disability status, and additional information about claims.
- Fill out information about the applicant in item 11 if you are not the worker, followed by details about the worker in items 12 to 19.
- Finally, review all entries for accuracy, and after signing the application, save any changes made and download or print the form for submission.
Complete your SSA-2490-BK form online today for timely processing of your benefits.
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Dec 27, 2006 - Application for Benefits Under a U.S. International Social Security...
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