TN 1 (03-97)
Belgian benefits are subject to reduction if certain family income levels are exceeded.
Family income includes income from a spouse's work and income from social welfare
benefits. Therefore, Belgium may require a declaration about income.
Follow this procedure if a Belgian liaison agency provides a copy of the income statement
and requests that it be completed.
Forward the form to the claimant or spouse as requested by the Belgian agency.
Diary the request for 60 days.
Send a follow-up and diary it for 30 days if no response is received.
Advise the Belgian agency if no response is received after the follow-up (i.e. after
When the income statement is returned to DIO, verify that the form has been signed;
and return the completed form to the Belgian agency.