Following is a description of the items on the form LUX/USA 3:
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Parts I and II contain information about the worker and claimants. The “verified” blocks in Part II are checked if the Luxembourg agency has verified the dates for
their claim.
Note: Dates are shown in year/mo/day format.
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Part III provides information about material that the Luxembourg agency is transmitting
with the liaison form.
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Part IV lists the information that the Luxembourg agency is requesting from SSA. This
section includes a Privacy Act Authorization to release information to Luxembourg.
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