The Form BE/USA 3 is printed in Flemish or in French. The Exhibit shown in the next
section contains an English translation of all items on the form. Following is a description
of the items on the Form BE/USA 3:
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Part I contains general information about the claim.
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Part II contains information about the worker and claimants.
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Part III provides information about material that the Belgian agency is transmitting
with the liaison form.
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Part IV lists the information that the Belgian agency is requesting from SSA. This
section includes a Privacy Act authorization to release information to Belgium.
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