Form SSA-2490-BK is available through MCS. Use the MCS version only when the Number Holder (NH) is filing for:
U.S. retirement or disability Totalization benefits only; orU.S. retirement or disability benefits (regular or Totalization) and concurrently for Italian benefits.
Do not use the MCS version of Form SSA-2490-BK when the applicant is filing for:
Italian benefits only; or U.S. or Italian survivor's benefits.Use the paper or electronic Form SSA-2490-BK for Totalization survivor claims. For instructions on how to complete the SSA-2490-BK, see GN 01702.110.
NOTE : If there is an existing U.S. Totalization life claim award, do not take an SSA-2490-BK in claims for U.S. auxiliary benefits or survivor claims. This is not required because an SSA-2490-BK was previously completed in connection with the NH's claim.
Use the following information to determine the application screens to complete when taking claims under the U.S. - Italian agreement for U.S. Totalization or Italian benefits.