When an applicant for Belgian benefits indicates coverage in the U.S. on the Belgian application and is not already a U.S. beneficiary, the Belgian agency routes a liaison Form BE/USA 3 to the FSP. The Belgian agency provides information on the form to identify the applicant and certifies the filing date. The Belgian agency also indicates on the form BE/USA 3, the need for a U.S. coverage record and other claims related information. If the Belgian coverage record has been established, the agency includes a copy.

Follow the procedures below which explain how the FSP should process referrals from the Belgian agency.

1. 1. 

   Claimant is eligible for U.S. Benefits

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     If the claimant meets the age and QC requirements for U.S. benefits, obtain Form SSA-2490-F4 (Part I) and the appropriate RSDI applications and evidence, OR obtain a signed statement that the claimant does not want to file a claim.

   • •

     Forward claims to IBO in DIO with the liaison Form BE/USA 3 and the Belgian coverage record.

   If the Belgian agency has requested information from DIO on form BE/USA 3, attach a flag to the material with the following information:

   The Belgian agency has requested information on this case. After award or disallowance action, forward the folder to a BET in the DIO modules.

   • •

     Forward a signed statement to the modules in DIO if the claimant does not want to file a claim.

2. 2. 

   Claimant is not Eligible for U.S. Benefits or is Already Entitled

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     If the claimant is clearly not eligible for U.S. benefits or is already entitled, no claims development action is necessary.

   • •

     If the Belgian agency has requested information, forward Form BE/ USA 3 and any attached material to the modules in DIO. If no information was requested, destroy the Belgian agency forms.