POMS Reference

This change was made on Dec 26, 2017. See latest version.
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GN 01745.220: Application Forms for Japanese Benefits

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  • Effective Dates: 04/15/2010 - Present
  • Effective Dates: 12/26/2017 - Present
  • 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:
  • The special Japanese application forms are taken in the field offices (FO). If an applicant wishes to file for Japanese benefits, the FO should:
  • * Access the Totalization Benefits Resource Kit on the intranet at http://ocoweb/oio/Totalization/TotResKit.asp
  • * Print the appropriate Japanese application form (J/USA 1 or J/USA 2) and instructions and give them to the applicant for completion.
  • * 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.
  • * Request an “Informational/Certified Earnings Record” (ICERS) per MSOM ICERS 001.004.
  • * Photocopy and certify any documents (evidence) submitted by the applicant.
  • * 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
  • * 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.
  • * 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
  • * 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 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.
  • 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.