Certificate of Coverage Request via Letter - Employers (Poland)

International Programs - Totalization Agreement with the Netherlands

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Social Security
The Official Website of the U.S. Social Security Administration

International Programs
International Programs home / Totalization Agreement with the Netherlands

Totalization Agreement with the Netherlands
SSA Publication No. 05-10196, March 2011, ICN 469045 [OMB Approval Number: 0960-0554 Expires 10/31/2013]

Contents
Introduction
Coverage and Social Security taxes
Certificate of coverage
Monthly benefits
What you need to know about Medicare
Claims for benefits
For more information

Introduction
An agreement effective November 1, 1990, between the United States and the Netherlands improves social security
protection for people who work or have worked in both countries. It helps many people who, without the agreement, would not
be eligible for monthly retirement, disability or survivors benefits under the social security system of one or both countries. It
also helps people who would otherwise have to pay social security taxes to both countries on the same earnings.
The agreement covers social security taxes (including the U.S. Medicare portion) and social security retirement, disability and
survivors benefits. It does not cover benefits under the U.S. Medicare program or Supplemental Security Income program.
This booklet covers highlights of the agreement and explains how it may help you while you work and when you apply for
benefits.

The Agreement May Help You, Your Family And Your Employer
• While you work––If your work is covered by both the U.S. and Dutch social security systems, you (and your
employer, if you are employed) normally would have to pay social security taxes to both countries for the same work.
However, the agreement eliminates this double coverage so you pay taxes to only one system (see the section on
"Coverage and Social Security taxes").

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• When you apply for benefits––You may have some social security credits in both the United States and the
Netherlands but not have enough to be eligible for benefits in one country or the other. The agreement makes it
easier to qualify for benefits by letting you add together your social security credits in both countries. For more details,
see the section on "Monthly Benefits".

Coverage And Social Security Taxes
Before the agreement, employees, employers and self-employed people could, under certain circumstances, be required to
pay social security taxes to both the United States and the Netherlands for the same work.
Under the agreement, if you work as an employee in the United States, you normally will be covered by the United States,
and you and your employer will pay Social Security taxes only to the United States. If you work as an employee in the
Netherlands, you normally will be covered by the Netherlands, and you and your employer pay social security taxes only to
the Netherlands.
On the other hand, if your employer sends you from one country to work for that employer or an affiliate in the other country
for five years or less, you will continue to be covered by your home country and you will be exempt from coverage in the other
country. For example, if a U.S. company sends an employee to work for that employer or an affiliate in the Netherlands for no
more than five years, the employer and employee will continue to pay only U.S. Social Security taxes and will not have to pay
in the Netherlands.
If you are self-employed and reside in the United States or the Netherlands, you generally will be covered and taxed only by
the country where you reside.
Note
In addition to the Dutch social security taxes that cover old-age, disability and survivors benefits, the agreement also
includes the Dutch taxes that cover health and sickness insurance benefits, unemployment benefits and family
allowances. As a result, workers exempted from Dutch social security coverage by the agreement pay no social
security taxes for these programs and generally cannot receive benefits from them. If the agreement exempts you
from Dutch coverage, you and your employer may wish to arrange for alternative benefit protection.

Summary Of Agreement Rules
The following table shows whether your work is covered under the U.S. or Dutch social security system. If you are covered
under U.S. Social Security, you and your employer (if you are an employee) must pay U.S. Social Security taxes. If you are
covered under the Dutch system, you and your employer (if you are an employee) must pay Dutch social security taxes. If you
are self-employed and reside in the United States or the Netherlands, you will generally be covered and taxed only by the
country where you reside. "Certificate of coverage" section explains how to get a form from the country where you are
covered that will prove you are exempt in the other country.
Your work status

Coverage and taxes

You are working in the Netherlands:

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For a U.S. employer who:
U.S.
• Sent you to work in the
Netherlands for five years or less

Netherlands
• Sent you to work in the
Netherlands for more than five
years

Netherlands
• Hired you in the Netherlands

For a non-U.S. employer

Netherlands

For the U.S. government and you are a:

U.S. (either Social Security or
• U.S. national

federal retirement program

Netherlands
• Dutch national

You are working in the U.S.:
For an employer in the Netherlands who:
Netherlands
• Sent you to work in the U.S. for five
years or less

U.S.
• Sent you to work in the U.S. for
more than five years

U.S.
• Hired you in the U.S.

For a non-Dutch employer

U.S.

For the Dutch government and you are a:

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Netherlands
• Dutch national

U.S.
• U.S. national

You are self-employed and you:
U.S.
• Reside in the U.S.

Netherlands
• Reside in the Netherlands

Note
As the table indicates, a U.S. worker employed in the Netherlands can be covered by U.S. Social Security only if he
or she works for a U.S. employer. A U.S. employer includes a corporation organized under the laws of the United
States or any state, a partnership if at least two-thirds of the partners are U.S. residents, a person who is a resident
of the U.S. or a trust if all the trustees are U.S. residents. The term also includes a foreign affiliate of a U.S.
employer if the U.S. employer has entered into an agreement with the Internal Revenue Service (IRS) under section
3121(l) of the Internal Revenue Code to pay Social Security taxes for U.S. citizens and residents employed by the
affiliate.

Certificate Of Coverage
A certificate of coverage issued by one country serves as proof of exemption from social security taxes on the same earnings
in the other country.

Certificates For Employees
To establish an exemption from compulsory coverage and taxes under the Dutch system, your employer must request a
certificate of coverage (form USA/NL 101) from the United States at this address:
Social Security Administration
Office of International Programs
P.O. Box 17741
Baltimore, Maryland 21235-7741
U.S.A.

If preferred, the request may be sent by FAX to (410) 966-1861. Please note this FAX number should only be used to request
certificates of coverage.
No special form is required to request a certificate but the request must be in writing and provide the following:

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• Full name of worker (including maiden name for married woman);
• Date and place of birth;
• Citizenship;
• Country of worker's permanent residence;
• U.S. Social Security number;
• Name (including maiden name of wife), relationship and date of birth of family members accompanying the worker;
• Date of hire;
• Country of hire;
• Name and address of the employer in the United States and the Netherlands; and
• Date of transfer and anticipated date of return.
In addition, your employer must indicate if you remain an employee of the U.S. company while working in the Netherlands or if
you become an employee of the U.S. company's affiliate in the Netherlands. If you become an employee of an affiliate, your
employer must indicate if the U.S. company has an agreement with the Internal Revenue Service (IRS) under section 3121(l)
of the Internal Revenue Code to pay U.S. Social Security taxes for U.S. citizens and residents employed by the affiliate and, if
yes, the effective date of the agreement.
Your employer also can request a certificate of U.S. coverage for you over the Internet using a special online request form
available at www.socialsecurity.gov/coc. Only an employer can use the online form to request a certificate of coverage. A
self-employed person must submit a request by mail or fax.
To establish your exemption from coverage under the U.S. Social Security system, your employer in the Netherlands must
request a certificate of coverage (form NL/USA 101) from the Netherlands at this address:
Sociale Verzekeringsbank
(Social Insurance Bank)
Department For International Secondment
Van Heuven Goedhartlaan 1
P.O. Box 357
1180 KJ Amstelveen
THE NETHERLANDS

The same information required for a certificate of coverage from the United States is needed to get a certificate of coverage
from the Netherlands except that you must show your Dutch social security number rather than your U.S. Social Security
number.

Certificates For Self-Employed People
If you are self-employed and would normally have to pay social security taxes to both the U.S. and Dutch sys-tems, you can
establish your exemption from one of the taxes:
• If you reside in the United States, write to the Social Security Administration at the address in "Certificates for
employees" section; or
• If you reside in the Netherlands, write to the Sociale Verzekeringsbank at the address in "Certificates for employees"
section.

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Be sure to provide the following information in your letter:
• Full name of worker (including maiden name for married woman);
• Date and place of birth;
• Citizenship;
• Country of permanent residence;
• U.S. and/or Dutch social security number;
• Name (including maiden name of wife), relationship and date of birth of family members accompanying the worker;
• Nature of self-employment activity;
• Dates the activity was or will be performed; and
• Name and address of your business in both countries.

Effective Date Of Coverage Exemption
The certificate of coverage you receive from one country will show the effective date of your exemption from paying social
security taxes in the other country. Generally, this will be the date you began working in the other country, but no earlier than
the effective date of the agreement.
Certificates of coverage issued by the Netherlands should be retained by the employer in the United States in case of an
audit by the IRS. No copies should be sent to the IRS unless specifically requested by the IRS. However, a self-employed
person must attach a photocopy of the certificate to his or her income tax return each year as proof of the U.S. exemption.
Copies of certificates of coverage issued by the United States will be provided for both the employee and em-ployer. It will be
their responsibility to present the certificate to the Dutch authorities when requested to do so. To avoid any difficulties, your
employer (or you, if you are self-employed) should request a certificate of coverage as early as possible, preferably before
your work in the other country begins.
If you or your employer request a certificate of coverage, you should read the Privacy Act and Paperwork Reduction Act
statements at the end of this booklet.

Authority to collect information for a certificate of coverage
Privacy Act
Section 233 of the Social Security Act as amended, [42 U.S.C. 433] authorizes us to collect this information. We will
use the information you provide to determine if your current work should be covered only under the U.S. Social
Security system in accordance with a Totalization agreement. The information you provide on this form is voluntary.
However, failure to provide all or part of the requested information may prevent us from making an accurate and
timely decision on your request for a certificate of coverage. Without the certificate, current work may continue to be
subject to coverage and taxation under both the U.S. and the foreign Social Security systems.
We rarely use the information you provide on this form for any purpose other than for the reasons explained above.
However, we may use it for the administration and integrity of Social Security programs. We may also disclose
information to another person or to another agency in accordance with approved routine uses, which include but are
not limited to the following:

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1. To enable a third party or an agency to assist Social Security in establishing rights to Social Security benefits
or coverage;
2. To comply with Federal laws requiring the release of information from Social Security records (e.g., to the
Government Accountability Office, General Services Administration, National Archives Records
Administration, and the Department of Veterans Affairs);
3. To make determinations for eligibility in similar health and income maintenance programs at the Federal,
State, and local level; and
4. To facilitate statistical research, audit, or investigative activities necessary to assure the integrity of Social
Security programs.
We may also use the information you provide in computer matching programs. Matching programs compare our
records with records kept by other Federal, State, or local government agencies. Information from these matching
programs can be used to establish or verify a person’s eligibility for Federally-funded or administered benefit
programs and for repayment of payments or delinquent debts under these programs.
A complete list of routine uses for this information is available in our System of Records Notice entitled, Earnings
Records and Self-Employment Income System, 60-0059. This notice, additional information regarding this form, and
information regarding our programs and systems, are available on-line at www.socialsecurity.gov or at any Social
Security office.
Paperwork Reduction Act Notice
This information collection meets the clearance requirements of 44 U.S.C. section 3507, as amended by section 2 of
the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of
Management and Budget control number. We estimate that it will take you about 44
30 minutes to read the instructions,
gather the necessary facts, and answer the questions to request a certificate of coverage.

Monthly Benefits
The following table shows the various types of social security benefits payable under the U.S. and Dutch systems and briefly
describes the eligibility requirements that normally apply for each type of benefit. If you do not meet the normal requirements
for these benefits, the agreement may help you to qualify (see "How benefits can be paid" section).
Dutch benefits are paid under the following laws:
• ANW (General Surviving Relatives Act)
• WIA (Work and Income According to Labour Capacity Act)
• Wajong (Disablement Assistance Act for Handicapped Young Persons)
• WAO (Disablement Insurance Act [previous scheme])
• WAZ (Self-Employed Persons Disablement Benefits Act)
This table is only a general guide. You can get more specific information about U.S. benefits at any U.S. Social Security office
or by using the contact information in "For more information" section of this publication. You can get more detailed information
about the Dutch system by writing to the Dutch address in "For more information" section of this document or by visiting the
Sociale Verzekeringsbank’s website at www.svb.org.

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Under U.S. Social Security, you may earn up to four credits each year depending on the amount of your covered earnings.
The amount needed to earn a work credit goes up slightly each year. For more information, ask for How You Earn Credits
(Publication No. 05-10072). Under the Dutch system, credits are measured in months. To simplify the information in the table,
requirements are shown in years of credits.

Monthly Benefits And Eligibility Requirements
Retirement or old-age benefits
United States

Netherlands

Worker-Full benefit at full retirement

Worker-Full benefits payable at age

age. Required work credits range from

65 with 50 years of coverage under

1 ½ to 10 years (10 years if age 62 in

the AOW; proportionately reduced

1991 or later).

pension if fewer than 50 years.
Minimum of one year of AOW
coverage needed to qualify.
Disability benefits

United States

Netherlands

Worker-Under full retirement age can

Worker-Four types of benefits are

get benefit if unable to do any

payable.

substantial gainful work for at least a
year. 1 ½ to 10 years credit needed,
depending on age at date of on-set.
Some recent work credits also needed
unless worker is blind.

1. WAO1—Person under age 65
can get benefits if they
became ill before 1/1/04 and
at least 15 percent disabled
for at least
104 weeks.
2. WAZ—Persons under age 65
can get benefits if illness
began on or after 11/1/2004
and at least 35% disabled for
at least 104 weeks.
3. WAZ2—People under age 65
can get benefits if at least 25%
disabled for at least 52 weeks.
Must be working in WAZ
covered self-employment at
disability onset.
Children—
4. Wajong—Persons living in the
Netherlands can get a benefit
if under age 65 and at least
25% disabled on the date of

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17th birthday or 25% disabled
by age 30 and a student for at
least 6 months prior to
disability onset.

Family benefits to dependents of retired or disabled people
United States

Netherlands

Spouse-Full benefit at full retirement

Spouse-No provision. However,

ageor at any age if caring for worker’s

beneficiaries who are married or share

entitled child under age 16 (or

a household with a person under age

disabled before age 22). Reduced

65 may receive a benefit supplement

benefit as early as age 62 if not caring

in addition to their pension.

for a child.
Divorced Spouse-Full benefit at full

Divorced Spouse-No provision.

retirement age. Reduced benefit as
early as age 62. Must be unmarried
and have been married
to worker for at least 10 years.
Children-If unmarried, up to age 18

Children-No provision.

(age 19 if in an elementary or
secondary school full time) or any age
if disabled before age 22.
Survivors benefits
United States

Netherlands

Widow or widower-Full benefit at full

Widow(er) or living with partner-

retirement ageor at any age if caring

Benefit payable to survivor if:

for deceased’s entitled child under
age 16 (or disabled before age 22).
Reduced benefit as early as age 60
(or age 50 if disabled) if not caring for
child. Benefits may be continued if

• Surviving relative is under age
65;
• Partner was insured under
ANW on the date of death;

remarriage occurs after age 60 (or
age 50 if disabled).

• Is caring for child(ren) under
age 18, or
• Is at least 45% occupationally
disabled.

Divorced widow or widower-Same

Divorced widow or widower-Benefit

as widow or widower if marriage

payable if not remarried or sharing a

lasted at least 10 years.

household with someone and would
have met the requirements for a

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widow or widower benefit if the former
spouse had died before the divorce
was final.
Children-Same as for children of

Children-Benefit payable if both

retired or disabled workers.

parents are deceased and the child is:
• Under age 16; or
• Under age 18 and disabled; or
• Under age 21 and
a student.
NOTE: If only one parent is deceased,
a reduced orphan's benefit is paid to
the person caring for a child who
meets the above requirements.

1

Lump-sum death benefit-A one-time

Lump-sum death benefit-A one-time

payment not to

payment equal to one monthly benefit

exceed $255 payable on the death of

and holiday allowance payable on

an insured worker.

death of the worker.

WIA replaced the old scheme WAO effective December 29, 2005. Disabilities on or after August 1, 2004, will be covered under WIA. WAO continues to

exist for people currently receiving benefits under the WAO.
2

WAZ benefit discontinued. Only self-employed persons who became occupationally disabled before August 1, 2004, can still receive WAZ benefits.

How Benefits Can Be Paid
If you have social security credits in both the United States and the Netherlands, you may be eligible for benefits from one or
both countries. If you meet all the basic requirements under one country’s system, you will get a regular benefit from that
country. If you do not meet the basic requirements, the agreement may help you qualify for a benefit as explained below.
• Benefits from the United States––If you do not have enough work credits under the U.S. system to qualify for
regular benefits, you may be able to qualify for a partial benefit from the United States based on both U.S. and Dutch
credits. However, to be eligible
to have your Dutch credits counted, you must have earned at least six credits (generally one and one-half years of
work) under the U.S. system. If you already have enough credits under the U.S. system to qualify for a benefit, the
United States cannot count your Dutch credits.
• Benefits from the Netherlands––Under the agreement, people who meet certain conditions can get an increased
Dutch old-age pension, or use their U.S. Social Security credits to help qualify for a Dutch disability or survivors
pension.
1. Old-age pension––A person can qualify for a Dutch old-age pension with as little as one year of Dutch
coverage. Therefore, work credits under the U.S. system will not be counted when determining eligibility for
the old-age pension.
The agreement does permit certain people to qualify for a higher benefit amount based on special credits for

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periods they resided in the Netherlands before 1957. To qualify for these special pre-1957 credits, you must
have earned some Dutch social security coverage after 1956 and meet certain eligibility requirements.
2. Disability and survivors pensions––Although there is no minimum coverage requirement for Dutch disability
or survivors pensions, the worker must have been covered under the Dutch system at the time the disability
began or at the time of death for a benefit to be payable. Under the agreement, the worker may meet this
requirement if he or she has credit for a minimum of 12 months of Dutch coverage and had recent U.S.
coverage (or was eligible for a U.S. benefit) at the time the disability began or at the time of death.

How Credits Get Counted
You do not have to do anything to have your credits in one country counted by the other country. If we need to count your
credits under the Dutch system to help you qualify for a U.S. benefit, we will get a copy of your Dutch earnings record directly
from the Netherlands when you apply for benefits. If the Netherlands needs to count your U.S. credits to help you qualify for a
Dutch benefit, they will get a copy of your U.S. earnings record directly from the Social Security Administration when you
apply for the Dutch benefit.
Although each country may count your credits in the other country, your credits are not actually transferred from one country
to the other. They remain on your record in the country where you earned them and also can be used to qualify for benefits
there.

Computation Of U.S. Benefit Under The Agreement
When a U.S. benefit becomes payable as a result of counting both U.S. and Dutch social security credits, an initial benefit is
determined based on your U.S. earnings as if your entire career had been completed under the U.S. system. This initial
benefit is then reduced to reflect the fact that Dutch credits helped to make the benefit payable. The amount of the reduction
will depend on the number of U.S. credits: the more U.S. credits, the smaller the reduction; and the fewer U.S. credits, the
larger the reduction.

A Dutch Pension May Affect Your U.S. Benefit
If you qualify for social security benefits from both the United States and the Netherlands and you did not need the agreement
to qualify for the U.S. benefit, the amount of your U.S. benefit may be reduced. This is a result of a provision in U.S. law that
can affect the way your benefit is figured if you also receive a pension based on work that was not covered by U.S. Social
Security. For more information, call our toll-free number, 1-800-772-1213, or visit our website, www.socialsecurity.gov, and
get a copy of Windfall Elimination Provision, (Publication No. 05-10045). If you are outside the United States, you may write to
us at the address in "For more information" section.

What You Need To Know About Medicare

Medicare is the U.S. national health insurance program for people age 65 or older or who are disabled. Medicare has four
parts:

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• Hospital insurance (Part A) helps pay for inpatient hospital care and certain follow-up services.
• Medical insurance (Part B) helps pay for doctor's services, outpatient hospital care and other medical services.
• Medicare Advantage plans (Part C) are available in many areas. People with Medicare Parts A and B can choose to
receive all of their health care services through a provider organization under Part C.
• Prescription drug coverage (Part D) helps pay for medications doctors prescribe for medical treatment.
You are eligible for free hospital insurance at age 65 if you have worked long enough under U.S. Social Security to qualify for
a retirement benefit. People born in 1929 or later need 40 credits (about 10 years of covered work) to qualify for retirement
benefits.
Although the agreement between the United States and the Netherlands allows the Social Security Administration to count
your Dutch credits to help you qualify for U.S. retirement, disability or survivors benefits, the agreement does not cover
Medicare benefits. As a result, we cannot count your credits in the Netherlands to establish entitlement to free Medicare
hospital insurance.
For more information about Medicare ask for Medicare (Publication No. 05-10043)or visit Medicare’s website at
www.medicare.gov.

Claims For Benefits

If you live in the United States and wish to apply for U.S. or Dutch benefits:
• Visit or write any U.S. Social Security office; or
• Phone our toll-free number, 1-800-772-1213, 7 a.m. to 7 p.m., Monday - Friday. People who are deaf or hard of
hearing may call our toll-free TTY number, 1-800-325-0778.
You can apply for Dutch benefits at any U.S. Social Security office by completing application form SSA-2490.
If you live in Netherlands and wish to apply for benefits, contact:
• The Federal Benefits Unit at the U.S. Embassy in Dublin, Ireland (phone 353-1-6687-122, ext. 2112) to file for U.S.
benefits, or
• Any Dutch social security office to file for Dutch benefits.
You can apply with one country and ask to have your application considered as a claim for benefits from the other country.
Information from your application will then be sent to the other country. Each country will process the claim under its own
laws—counting credits from the other country when appropriate—and notify you of its decision.
If you have not applied for benefits before, you may need to provide certain information and documents when you apply.
These include the worker’s U.S. and Dutch social security numbers, proof of age for all claimants, evidence of the worker’s
U.S. earnings in the past 24 months and information about the worker’s coverage under the Dutch system. You may wish to
call the Social Security office before you go there to see if you need any other information.

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Payment Of Benefits
Each country pays its own benefit. U.S. payments are made by the U.S. Department of Treasury each month and cover
benefits for the preceding month. The Netherlands also pays benefits each month for the preceding month.

Absence From U.S. Territory
Normally, persons who are not U.S. citizens may receive U.S. Social Security benefits while outside the United Sates only if
they meet certain requirements. Under the agreement, however, you may receive benefits as long as you reside in the
Netherlands regardless of your nationality. If you are not a U.S. or Dutch citizen and live in another country, you may not be
able to receive benefits. The restrictions on U.S. benefits are explained in the publication, Your Payments While You Are
Outside The United States (Publication No. 05-10137).

Appeals
If you disagree with the decision made on your claim for benefits under the agreement, contact any U.S. or Dutch social
security office. The people there can tell you what you need to do to appeal the decision.
The Dutch social security authorities will review your appeal if it affects your rights under the Dutch system, while U.S. Social
Security authorities will review your appeal if it affects your rights under the U.S. system. Since each country’s decisions are
made independently of the other, a decision by one country on a particular issue may not always conform with the decision
made by the other country on the same issue.

For More Information
To file a claim for U.S. or Dutch benefits under the agreement, follow the instructions in "Claims for benefits" section.
If you live outside the United States, write to:
Office of International Operations (OIO)
OIO—Totalization
P.O. Box 17769
Baltimore, MD 21235-7769
USA

For more information about the Dutch social security programs, contact any social security office in the Netherlands:
• If you do not live in the Netherlands and you want information about retirement, survivors or child’s benefits, write to:
Sociale Verzekeringsbank
Postbus 576
9700 An Groningen
THE NETHERLANDS; or

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• If you live outside the Netherlands and want information about disability benefits, contact:
GAK NL BV
Postbus 8300
1005 CA Amsterdam
THE NETHERLANDS

If you do not wish to file a claim for benefits but would like more information about the agreement, write to:
Social Security Administration
Office of International Programs
P.O. Box 17741
Baltimore, MD 21235-7741
USA

For additional information visit our website: www.socialsecurity.gov/international.

Contacting Social Security

Visit Our Website
Our website, www.socialsecurity.gov, is a valuable resource for information about all of Social Security’s programs. At our
website you can:
• Request a Social Security Statement, replacement Medicare card or proof of income letter;
• Get forms to request a Social Security card

; and

• Find copies of our publications.

Call Our Toll-Free Number
In addition to using our website, you also can call us toll-free at 1-800-772-1213. We treat calls confidentially. We can answer
specific questions from 7 a.m. to 7 p.m., Monday through Friday. We can provide information by automated phone service 24
hours a day. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778.
We also want to make sure you receive accurate and courteous service. That is why we have a second Social Security
representative monitor some telephone calls.

Last reviewed or modified 02/27/2013

http://mwww.ba.ssa.gov/international/Agreement_Pamphlets/netherld.html

6/6/2013