Effective Dates: 04/25/2017 - Present Previous | Next

Basic (04-09)

GN 01750.012 How the Foreign Service Post in Warsaw, Poland Processes and Develops Claims Filed With the Czech Republic Agency

A. Process

When a person not eligible for Czech benefits contacts the Czech Republic agency, CSSZ to file a claim for U.S. benefits, CSSZ sends the following information to the FSP in Warsaw, Poland:

  • •

    SSA-2490-BK (Application for Benefits under the U.S. International Social Security Agreement) and Supplemental Questionnaire (This form can be located on the Division of International Operations website).

  • •

    A liaison form, SSA-e2960-U3-CZ(Transmittal/Request/Certification Form-CZ/USA3), certifying the filing date for the claim.

  • •

    Czech certified coverage record (CZ/USA205)

  • •

    Available medical evidence if the claim is for disability benefits.

B. Procedure

This procedure explains how the FSP in Warsaw, Poland should process referrals from CSSZ.

1. Claimant entitled to U.S. benefits

Forward all material to DIO annotated “already entitled to U.S. benefits”.

2. Claimant not entitled to US benefits

Process the claim in the same manner shown in GN 01750.010B.

C. Reference

MSOM MCS 009.011 TOTALIZATION (TOTL)

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201750012
GN 01750.012 - How the Foreign Service Post in Warsaw, Poland Processes and Develops Claims Filed With the Czech Republic Agency - 04/25/2017
Batch run: 04/25/2017
Rev:04/25/2017