Effective Dates: 06/15/2017 - Present Previous | Next

TN 1 (03-97)

GN 01714.235 Facts about the Belgian Liaison Form

A. Policy

The transmittal/request Form BE/USA 3 is the agreed upon form for a Belgian agency to:

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    transmit material to DIO or the FSP in Brussels,

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    send information to DIO or the FSP, and

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    request information from DIO.

B. Description of form BE/USA 3

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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    Part V contains remarks.

C. Exhibit - Belgium - U.S. agreement on social security transmittal /request /certification - BE/USA 3

 

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To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201714235
GN 01714.235 - Facts about the Belgian Liaison Form - 06/15/2017
Batch run: 06/15/2017
Rev:06/15/2017