Prepare initial claims packages to request Czech Republic certified coverage records
and to inform CSSZ about claims for Czech benefits.
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.
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.
GN 01750.205 – GN 01750.220, Application and Evidence for Czech Agreement