BASIC (10-05)

GN 01746.235 Facts About the Japanese Liaison Form J/USA 3

A. Procedure - When to Use Form J/USA3

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.

B. Exhibit - Form J/USA 3 - Transmittal/Request/Certification Form

G-J-USA_3-1

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G-J-USA_3-2

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C. Description of Form J/USA 3

1. Part 1

Part 1 contains information about the claim and claimant.

2. Part 2

Part 2 contains certification of data. If verified, the appropriate block will be checked.

3. Part 3

Part 3 contains information provided by the Japanese agency, including medical evidence in disability claims.

4. Part 4

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.

5. Part 5

Part 5 contains any necessary remarks.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0201746235
GN 01746.235 - Facts About the Japanese Liaison Form J/USA 3 - 10/06/2005
Batch run: 01/27/2009
Rev:10/06/2005