Basic (04-09)
Prepare a SSA-2960 (Transmittal/Request/Certification Form - USA/CZ3) Please add the title of the form if a Czech Republic certified coverage record is required and has not been requested.
Prepare a SSA-2960 (Transmittal/Request/Certification Form - USA/CZ3) to:
Request the Czech Republic certified coverage record and include a copy of the SSA-2960 (Transmittal/Request/Certification Form- USA/CZ3).
Send CSSZ the information or documentation they have requested.