BASIC (09-05)

GN 01745.220 Application Forms for Japanese Benefits

A. Introduction

All applicants for Japanese benefits must complete a special Japanese application form. The form(s) to be completed vary depending on the type of benefit claimed. The special Japanese application forms are:

  • The J/USA 1 (Application for Old-Age or Disability Pension) is used to claim a retirement or disability pension from Japan.

  • The J/USA 2 (Application for Survivors Pensions) is used to claim survivors’ benefits from Japan.

The Japanese application forms are in a bilingual Japanese-English format and are available through the Totalization Benefits Resource Kit on the Intranet at http://ocoweb/oio/Totalization/TotResKit.asp .

NOTE: Field offices shouldn’t accept a claim for Japanese benefits until 1 month prior to entitlement. Also no signatures are needed on these Japanese application forms.

B. Procedure - Required Application for Japanese Benefits

The special Japanese application forms are taken in the field offices (FO's). If an applicant wishes to file for Japanese benefits, the FO should:

  1. Access the Totalization Benefits Resource Kit on the intranet at http://ocoweb/oio/Totalization/TotResKit.asp

  2. Print the appropriate Japanese application form (J/USA 1 or J/USA 2) and instructions and give them to the applicant for completion.

  3. Provide any necessary assistance in completing the Japanese form.

    NOTE: Most individuals filing for Japanese benefits should be able to complete the Japanese application form without assistance using the instructions provided with the application.

  4. Request an “Informational/Certified Earnings Record” (ICERS) per MSOM ICERS 001.004.

  5. Photocopy and certify any documents (evidence) submitted by the applicant.

  6. Send the completed Japanese application form, certified copies of evidence and certified earnings record(s) (ICERS) to the Office of International Operations (OIO) in Baltimore at the following address:

    Social Security Administration
    OIO - Totalization
    P.O. Box 17049
    Baltimore, Maryland 21235-7049
  7. Complete the Modernized Development Worksheet (MDW) screen to show the date the Japanese claim is forwarded to OIO. Show “Totalization” as the ISSUE when completing the MDW screen.

Once OIO receives the claim, OIO will send the claim directly to the Japanese agency along with the evidence and the worker’s U.S. coverage record.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201745220
GN 01745.220 - Application Forms for Japanese Benefits - 04/15/2010
Batch run: 04/15/2010
Rev:04/15/2010