Belgian benefits are subject to reduction if certain family income levels are exceeded. Family income includes income from the spouse's work and income from other social benefits. Therefore, Belgium may require a claimant and spouse to sign a declaration about income. The United States will obtain an income statement from the claimant and spouse only upon specific request from Belgium. The Belgian agencies will provide English language forms with their requests.

Send the forms directly to the individual for completion. Enclose a totalization-addressed, blue, return envelope. When the completed form is received, ensure it is signed but do not attempt to verify the accuracy of the information. Forward the form to the appropriate Belgium agency using Form SSA-2960-U2-BE.