In addition to Form SSA-2490-BK, an applicant for Belgian benefits must complete one or more special Belgian application forms. The form(s) to be completed vary depending on the type of benefit claimed.

The special Belgian application forms are not taken in the field offices (FO). After receiving a claim for Belgian benefits that was filed with SSA, the Belgian agency will mail the appropriate Belgian application form to the applicant. The Belgian agency will include instructions asking the claimant to complete the forms and mail them directly to the Belgian agency with any additional evidence that may be needed.

If an applicant brings one of the Belgian application forms to the FO, the FO should:

1. 1. 

   Provide any necessary assistance in completing the form(s).

2. 2. 

   Photocopy and certify any documents (evidence) the Belgian agency has requested the applicant to include with the Belgian claim.

3. 3. 

   Return the form(s) and certified photocopies to the applicant and advise the applicant to mail the documents directly to the Belgian agency that sent them.

4. 4. 

   Advise the applicant to check with the U.S. Postal Service for the international rate and/or fee for mailing materials to Belgium.

Reminder: Don’t mail the Belgian application forms to Division of International Operations.