GN 01749.220: Additional Application Form for Czech Benefits
Effective Dates: 03/12/2009 - Present
- BASIC (03-09)
- GN 01749.220 Additional Application Form for Czech Benefits
- A. Introduction
- Form CZ/USA 202, Claim for a Pension from the Czech Republic, is used to take claims for Czech benefits (solely or with U.S. Totalization) from persons filing the application in a field office (FO). This section explains how to download the application form and how to take a claim for Czech benefits using the Czech application form.
- B. Claims Representative takes required application for Czech benefits
- If an applicant files for Czech benefits:
* Access the Totalization Benefits Resource Kit on the intranet at http://ocoweb.ba.ssa.gov/oio/SSA%20Tot%20Res%20Kit/TotalResKit2.asp
- * Print the Czech application form (CZ/USA 202) and instructions. Give them to the applicant for completion.
- * Provide assistance in completing the Czech form.
- * Request an “Informational/Certified Earnings Record” (ICERS) per MSOM ICERS 001.004.
- * Photocopy, stamp, and sign evidence submitted by the applicant.
* Send the completed Czech application form, certified copies of evidence, and certified earnings record (ICERS) to the Office of International Operations (OIO) in Baltimore at the following address:Social Security AdministrationOIO – TotalizationP.O. Box 17769Baltimore, Maryland 21235-7769 NOTE: OIO sends the claim to the Czech agency with the evidence and the worker’s U.S. coverage record. * Complete the Modernized Development Worksheet (MDW) screen showing the date you sent the Czech claim to OIO. Show “Totalization” as the ISSUE when completing the MDW screen.
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