Basic (10-05)
Japanese agencies use form J/USA 3 to:
Transmit material to OIO or VARO
Send information to OIO or VARO, and
Request information from OIO.
View In PDF
Part 1 contains information about the claim and claimant.
Part 2 contains certification of data. If verified, the appropriate block will be checked.
Part 3 contains information provided by the Japanese agency, including medical evidence in disability claims.
Part 4 contains a list of the type of information that the Japanese agency might request from OIO/VARO along with the remark that the information is needed to process a claim under the agreement or that a consent statement is attached.
Part 5 contains any necessary remarks.