BASIC (04-09)

GN 01750.205 Preparing Claims Packages in DIO for Claims Filed Outside of the Czech Republic

A. Procedure – Initial claims packages

Prepare initial claims packages to request Czech Republic certified coverage records and to inform CSSZ about claims for Czech benefits.

B. Procedure – U.S. claims

Prepare form SSA-e2960-U3-CZ (Transmittal/Request/Certification -USA/CZ3) and forward it to CSSZ if the Czech record is not in the claims file.

C. Procedure - U.S. claims/Czech totalization benefits

Prepare a claims package that includes:

  • Form SSA-e2960-U3-CZ USA/CZ3 to request a Czech Republic certified coverage record if needed and to certify the filing date for Czech benefits, establish factors of entitlement, and U.S. benefit information.

  • A U.S. totalization earnings record.

  • Medical evidence from SSA’s files, if the Czech claim is for disability benefits.

  • CZ/USA 202 and any necessary proofs and any evidence

  • Letter to claimant advising them that their claim was forwarded to the Czech Republic Agency if claim is for Czech benefits only.

D. Reference

GN 01750.205 GN 01750.220, Application and Evidence for Czech Agreement


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201750205
GN 01750.205 - Preparing Claims Packages in DIO for Claims Filed Outside of the Czech Republic - 04/26/2017
Batch run: 04/26/2017
Rev:04/26/2017