BASIC (09-05)

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). 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 Earnings and International Operations (OEIO)/Division of International Operations (DIO) in Baltimore at the following address:

   
   Social Security Administration
   OEIO/DIO
   P.O. Box 17769
   Baltimore, Maryland 21235-7769

7. Complete the Modernized Development Worksheet (MDW) screen to show the date the Japanese claim is forwarded to OEIO/DIO. Show “Totalization” as the ISSUE when completing the MDW screen.

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