TN 1 (09-05)

A. Process

The following steps describe the process for issuing a certificate of coverage:

• The employer (in the case of employment) or the worker (in the case of self-employment) writes to the appropriate authority requesting a certificate.

  NOTE: The employer's or worker's representative (e.g., attorney or accounting firm) may request the certificate on the employer's or worker's behalf.

• The Social Security Administration (in the case of U.S. certificates) or the local Japanese social insurance agency (in the case of Japanese certificates) issues the certificate, if appropriate.

• The issuing agency sends the original and one copy to the requestor.

• If the person is employed, the employer or worker presents the certificate to the tax authorities in the other country when requested to do so.

• If the person is a self-employed U.S. citizen who is subject only to Japanese laws under the agreement, he or she must attach a photocopy of the Japanese certificate to his or her U.S. income tax return each year.

B. Procedure

1. Required Information

Advise the person to provide the following information when writing to get a certificate of coverage:

• Full name of worker;

• Social Security number when requesting a U.S. certificate or the Basic Pension number when requesting a Japanese certificate;

• Country of citizenship;

• Date and place of birth;

• Country of permanent residence;

• Name and address of employer in both countries if employed or address of trade or business in both countries if self-employed;

• Nature of trade or business, if self-employed;

• Date and place of hire by employer transferring the employee, if employed;

• Beginning date and ending date of employment or self-employment in the other country;

• If the transfer is from the United States to Japan, a statement indicating whether or not the worker and any accompanying family members are covered by a employer-sponsored or other private health insurance plan while in Japan; and

• A statement indicating whether the employee will remain an employee of the U.S. company while working in Japan or will become an employee of a Japanese company.

NOTE: If the worker will be an employee of a Japanese affiliate of an American employer, the request must indicate whether the American employer has entered into an agreement with the Internal Revenue Service under section 3121(l) of the Internal Revenue Code and, if yes, the effective date of such an agreement.

2. Where to Send Request for Certificate

Advise the person to send the request to the appropriate address below.

a. For U.S. Certificates

Advise the person to send the request for a U.S. certificate of coverage (form USA/J 6) to the following address:

NOTE: Employers who have access to the Internet can request U.S. certificates of coverage over the Internet. See www.socialsecurity.gov/international for more information about requesting U.S. certificates of coverage via the Internet. Only an employer can use the online form to request a certificate of coverage. A self-employed person must submit a request by mail or fax.

If preferred, the request may be sent by fax to 410-966-1861. Please note this FAX number is only for requesting U.S. certificates of coverage.

b. For Japanese Certificates

Advise the person who wants to get a Japanese certificate of coverage (form J/USA 6) to write to the local Japanese social insurance agency that collects the Japanese Social Security taxes.

C. Reference

RS 01901.070, Agreement under section 3121(l) of the Internal Revenue Code