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The same information required for a certificate of coverage from the United States is needed to get a certificate from Japan except
that:

« You must show your Japanese Basic Pension number rather than your U.S. Social Security number; and
e Your employer doesn't need to certify whether you and your family are or are not covered by private health insurance.

Certificates For Self-Employed People

If you are self-employed and would normally have to pay Social Security taxes to both the U.S. and Japanese systems, you can
establish your exemption from one of the taxes.

If you will be covered by the United States (see the following table ), write to the U.S. Social Security Administration at the
address in "Certificates for employees" section; or

If you will be covered by Japan (see the following table ), write to the local Japanese social insurance agency that collects your
Japanese Social Security taxes.

Be sure to provide the following information in your letter:

© Full name;

© Date and place of birth;

© Citizenship;

© Country of permanent residence;

© US. Social Security number and/or Japanese Basic Pension number;

© Nature of self-employment activity;

© Dates the activity was or will be performed;

© Name and address of your trade or business in both countries; and

© Ifyou are requesting a certificate from the United States, a statement certifying whether or not you, and all family members
who live with you in Japan, are or are not covered by a private health insurance plan while in Japan (see Note above)

Effective Date Of Coverage Exemption

The certificate of coverage you receive from one country will show the effective date of your exemption from paying Social Security
taxes in the other country. Generally, this will be the date you began working in the other country, but no earlier than the effective
date of the agreement.

Certificates of coverage issued by Japan should be retained by the employer in the United States in case of an audit by the Internal
Revenue Service (IRS). No copies should be sent to IRS unless specifically requested by IRS. However, a self-employed person must
attach a photocopy of the certificate to his or her income tax return each year as proof of the U.S. exemption.

Note
Japanese certificates of coverage will be issued using Japanese characters not Roman characters. It will be up to the employer in
the United States or the self-employed person to have the Japanese certificate translated.

Copies of certificates of coverage issued by the United States will be provided for both the employee and the employer. It will be
their responsibility to present the certificate to the Japanese authorities when requested to do so. To avoid any difficulties, your
employer (or you, if you are self-employed) should request a certificate as early as possible, preferably before your work in the
other country begins.

If you or your employer request a certificate of coverage, you should read the Privacy Act and Paperwork Reduction Act statements
below.

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Computation Of U.S. Benefit Under The Agreement

When a U.S. benefit becomes payable as a result of counting both U.S. and Japanese Social Security credits, an initial benefit is
determined based on your U.S. earnings as if your entire career had been completed under the U.S. system. This initial benefit is
then reduced to reflect the fact that Japanese credits helped to make the benefit payable. The amount of the reduction will depend
on the number of U.S. credits: the more U.S. credits, the smaller the reduction; and the fewer U.S. credits, the larger the reduction.

A Japanese pension may affect your U.S. benefit

If you qualify for Social Security benefits from both the United States and Japan and you did not need the agreement to qualify for
either benefit, the amount of your U.S. benefit may be reduced. This is a result of a provision in U.S. law that can affect the way your
benefit is figured if you also receive a pension based on work that was not covered by U.S. Social Security. For more information,
call our toll-free number, 1-800-772-1213, and get the publication, Windfall Elimination Provision (Publication No. 05-10045). If
you are outside the United States, you may write to us at the address in For more information section.

What you need to know about Medicare

Medicare is the U.S. national health insurance system for people age 65 or older or who are disabled. Medicare has two parts:
hospital insurance (also called "Part A" Medicare) and medical insurance (called "Part B" Medicare). You are eligible for free hospital
insurance at age 65 if you have worked long enough under U.S. Social Security to qualify for a retirement benefit. People born in
1929 or later need 40 credits (about 10 years of covered work) to qualify for retirement benefits.

Although the agreement between the United States and Japan allows the Social Security Administration to count your Japanese
credits to help you qualify for U.S. retirement, disability or survivor benefits, the agreement does not cover Medicare benefits. As a
result, we cannot count your credits in Japan to establish entitlement to free Medicare hospital insurance.

For more information about Medicare, call our toll-free number, 1-800-772-1213, and ask for the publication, Medicare
(Publication No. 05-10043) or visit Medicare's website at www.medicare.gov.

Claims for benefits

If you live in the United States and wish to apply for U.S. or Japanese benefits:

Visit or write any U.S. Social Security office; or
© Phone our toll-free number, 1-800-772-1213, 7 a.m. to 7 p.m. any business day. People who are deaf or hard of hearing may
call our toll-free TTY number, 1-800-325-0778.

You can apply for Japanese benefits at any U.S. Social Security office by completing an application form J/USA 1 to apply for
retirement or disability benefits or application form J/USA 2 to apply for survivors’ benefits.

If you live in Japan and wish to apply for U.S. or Japanese benefits, contact:

© The U.S. Embassy in Tokyo or the Social Security Division, Veterans Affairs Regional office, American Embassy, 1131 Roxas
Boulevard, 0930 Manila, PHILIPPINES, to file for U.S. benefits; or
© Any Japanese Social Security office to file for Japanese benefits.

You can apply with one country and ask to have your application considered as a claim for benefits from the other country.
Information from your application will then be sent to the other country. Each country will process the claim under its own laws—
counting credits from the other country when appropriate—and notify you of its decision.

If you have not applied for benefits before, you may need to provide certain information and documents when you apply. These
include the worker's U.S. Social Security number, the worker's Japanese Basic Pension number, proof of age for all claimants,
evidence of the worker's U.S. earnings in the past 24 months and information about the worker's coverage under the Japanese

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seamen and miners). A minimum of 25
years of coverage is required.

Disability benefits

United States

Japan

Worker-Under full retirement age can get Worker-

benefit if unable to do any substantial
gainful work for at least a year. One and
one-half to 10 years credit

needed, depending on age at date of
onset. Some recent work credits also
needed unless worker is blind.

NP-Class I disability benefits are payable if
totally disabled and require constant care.
Class II disability benefits are payable if
unable to work due to disability. The
person must be covered under NP (or, if
aged 60 through 64, be a resident of
Japan) on the date of the first medical
examination establishing the disability and
have coverage credited for at least two-
thirds of the period between age 20 and
the date of the medical examination.

EPI-Class I and Class II disability benefits
are payable. The person must be covered
under EPI on the date of the first medical
examination establishing the disability and
have coverage credited for at least two-
thirds of the period between age 20 and
the date of the medical examination.

Class Ill disability benefits are payable to
people with a partial disability that
doesn't prevent them from working. A
lump-sum disability allowance may be
payable if the degree of disability is less
than Class Ill.

Family benefits to dependents of retired or disabled people

United States

Spouse-Full benefit at full retirement age
or at any age if caring for the worker's
entitled child under age 16 (or disabled
before age 22). Reduced benefit as early
as age 62 if not caring for a child.

Divorced Spouse-Full benefit at full
retirement age. Reduced benefit as early
as age 62. Must be unmarried and have
been married to worker for at least

10 years.

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Japan
Spouse-

NP-No provision for spouse of retired or
disabled worker.

EPI-No provision. However, a supplement
is payable to a retired or disabled (Class I
or Class II only) worker who has at least 20
years of EPI coverage (not counting NP
coverage or exempt periods) and has a
dependent spouse. An additional
supplement is payable for a dependent
spouse under age 65.

Divorced Spouse-No provision under
either NP or EPI.

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Authority to collect information for a certificate of coverage
Privacy Act

|The Privacy Act requires us to notify you that we are authorized to collect this information by section 233 of the Social Security Act.

hile it is not mandatory for you to furnish the information to the Social Security Administration (SSA), a certificate of coverage
cannot be issued unless a request has been received. The information is needed to enable SSA to determine if work should be
covered only under the U.S. Social Security system in accordance with an international agreement. Without the certificate, work
Imay be subject to taxation under both the U.S. and the foreign Social Security systems.

Paperwork Reduction Act Notice

[This information collection meets the clearance requirements of 44 U.S.C. section 3507, as amended by section 2 of the Paperwork

Reduction Act of 1995. You are not required to answer these questions unless we display a valid Office of Management and Budget

(OMB) control number. We estimate that it will take you about 30 minutes to read the instructions, gather the necessary facts, and
rite down the information to request a certificate of coverage.

Monthly benefits

The following table shows the various types of Social Security benefits payable under the U.S. and Japanese Social Security systems
and briefly describes the eligibility requirements that normally apply for each type of benefit. If you do not meet the normal
requirements for these benefits, the agreement may help you to qualify (see "How benefits can be paid" section).

It is important to know that Japan pays benefits through a two-tiered program. The first tier, called the National Pension (NP), is a
contributory, universal program that covers all residents of Japan. The second tier is made up of four supplementary earnings-
related programs, the most important of which is called the Employees’ Pension Insurance (EPI). The EPI covers employed people in
commerce and industry, including miners and merchant seamen. The three other earnings-related programs cover distinct
occupational groups. The term EPI is sometimes used to refer to all four second-tier programs.

This table is only a general guide. You can get more specific information about U.S. benefits here on our web site or at any U.S.
Social Security office or by calling our toll-free number at 1-800-772-1213. You can get more detailed information about Japanese
benefits by writing to the Japanese system to which you pay Japanese Social Security taxes or by visiting the Japanese Social
Security system's website at www.ipss.go.jp/index-e.html.

Under U.S. Social Security, you may earn up to four credits each year depending on the amount of your covered earnings. The
amount needed to earn a work credit goes up slightly each year. For more information, see How You Earn Credits (SSA Publication
No. 05-10072).

Under the Japanese system, credits are measured in months. To simplify the information in the table, requirements are shown in
years of credits.

Monthly Benefits And Eligibility Requirements

Retirement or old-age benefits
United States Japan
Worker-Full benefit at full retirement age, Worker-
or reduced benefit as early as age 62.
Required work credits range from one and NP-Full retirement age is 65. Reduced

‘one-half to 10 years (10 years if 62 in 1991 benefits are payable as early as age 60. A
or later). minimum of 25 years of coverage is

required.

EPI-Full benefit at age 60 (age 55 for

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(age 20 if disabled)
6. grandparents age 55 or older

Lump-Sum Death Benefit-A one-time | Lump-Sum Death Benefit-
payment not to exceed $255 payable on

the death of an insured worker. NP-Benefit payable if the deceased

contributed for at least three years, was
not entitled to a benefit, and had
dependents who are not entitled to
survivors benefits.

EPI-No provision.
Refund of contributions

United States Japan

No refund of properly paid contributions. Foreign workers can receive a partial
refund of NP and EPI contributions if the
worker is not eligible for any Japanese
benefits, has contributed for six months or
longer under NP or EPI, left Japan after
November 8, 1994, and requests the
refund within two years after leaving
Japan.

How Benefits Can Be Paid

If you have Social Security credits in both the United States and Japan, you may be eligible for benefits from one or both countries.
If you meet all the basic requirements under one country’s system, you will get a regular benefit from that country. If you do not
meet the basic requirements, the agreement may help you qualify for a benefit as explained below.

© Benefits from the United States—If you do not have enough work credits under the U.S. system to qualify for regular
benefits, you may be able to qualify for a partial benefit from the United States based on both U.S. and Japanese credits.
However, to be eligible to have your Japanese credits counted, you must have earned at least six credits (generally one and
one-half years of work) under the U.S. system. If you already have enough credits under the U.S. system to qualify for a
benefit, the United States cannot count your Japanese credits.

© Benefits from Japan—Social Security credits from both countries can also be counted, when necessary, to meet the eligibility
requirements for Japanese benefits. To be eligible to have your U.S. and Japanese credits counted, you must have at least one
month of coverage credited under the Japanese system.

How Credits Get Counted

You do not have to do anything to have your credits in one country counted by the other country. If we need to count your credits
under the Japanese system to help you qualify for a U.S. benefit, we will get a copy of your Japanese record directly from Japan
when you apply for benefits. If Jagan needs to count your U.S. credits to help you qualify for a Japanese benefit, Japan will get a
copy of your U.S. record directly from the Social Security Administration when you apply for the Japanese benefit.

Although each country may count your credits in the other country, your credits are not actually transferred from one country to
the other. They remain on your record in the country where you earned them and can also be used to qualify for benefits there.

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Social Security

Official Social Security Website

International Programs

Totalization Agreement with Japan
SSA Publication No. 05-10165, August 2005, ICN 469150 [OMB Approval Number: 0960-0554 Expires 12/31/2016]

Contents

Introduction

Coverage and Social Security taxes

Certificate of coverage

Monthly benefits

A Japanese pension may affect your U.S. benefit
What you need to know about Medicare

Claims for benefits

For more information

Introduction

An agreement effective October 1, 2005, between the United States and Japan improves Social Security protection for people who
work or have worked in both countries. It helps many people who, without the agreement, would not be eligible for monthly
retirement, disability or survivors benefits under the Social Security system of one or both countries. It also helps people who would
otherwise have to pay Social Security taxes to both countries on the same earnings.

For the United States, the agreement covers Social Security taxes (including the U.S. Medicare portion) and Social Security
retirement, disability and survivors insurance benefits. It does not cover benefits under the U.S. Medicare program or the
Supplemental Security Income program.

For Japan, the agreement covers Social Security taxes (including the Japanese health insurance portion, in some cases) and Social
Security retirement, disability and survivors benefits. It doesn’t cover the National Pension Fund and the Employees’ Pension Fund
which are corporate pension funds under which participation and contributions are voluntary. The pension system for members of
local assemblies, a supplemental pension system for local government workers, is also not covered by the agreement. The
agreement also doesn't apply to the Old-Age Welfare Pension or other Japanese non-contributory, means-tested allowances paid
from general revenues.

This document covers highlights of the agreement and explains how it may help you while you work and when you apply for
benefits.

The Agreement May Help You, Your Family And Your Employer

© While you work—If your work is covered by both the U.S. and Japanese Social Security systems, you (and your employer, if
you are employed) would normally have to pay Social Security taxes to both countries for the same work. However, the
agreement eliminates this double coverage so you pay taxes to only one system (see "Coverage and Social Security taxes"
section).

When you apply for benefits—You may have some Social Security credits in both the United States and Japan but not have
enough to be eligible for benefits in one country or the other. The agreement makes it easier to qualify for benefits by letting
you add together your Social Security credits in both countries. For more details, see the section on "Monthly benefits"
section.

Coverage and Social Security taxes

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National Public Service

Mutual Aid

Local Public Service Mutual Aid

Private School Teachers’ and Employees’

Mutual Aid

If you do not wish to file a claim for benefits, but would like more information about the agreement, write to:

International Programs - Totalization Agreement with Japan

Federation of National Public
Service Personnel Mutual

Aid Associations

Pension Department

1-1-10, Kudanminami
Chiyoda-ku, Tokyo 102-8082
JAPAN

Pension Fund Association for Local
Government Officials

Pension Division

Pension Operation Department
Akasaka DS Building

8-5-26, Akasaka

Minato-ku, Tokyo 107-0052
JAPAN

The Promotion and Mutual Aid

Corporation for Private Schools of Japan

1-7-5, Yushima
Bunkyo-ku, Tokyo 113-8577
Japan

Social Security Administration
Office of International Programs
P.O. Box 17741

Baltimore, Maryland 21235-7741
USA.

For additional information visit our website: www.socialsecurity.gov/international.

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system. You may wish to call the Social Security office before you go there to see if any other information is needed.

Payment Of Benefits

Each country pays its own benefit. U.S. payments are made by the U.S. Department of Treasury each month and cover benefits for
the preceding month. Japanese benefits are paid by direct deposit on the 15th of even-numbered months in Japan and cover
benefits for the preceding month and the current month. For overseas payments, the benefit is paid by direct deposit
approximately three to seven days after the 15th of the month and also covers benefits for the preceding month and the current
month.

Absence From U.S. Territory

Normally, persons who are not U.S. citizens may receive U.S. Social Security benefits while outside the United States only if they
meet certain requirements. Under the agreement, however, if you are a U.S. or Japanese citizen, a refugee, a stateless person, or a
person who is eligible for dependents or survivors benefits based on the Social Security record of one of these people, you may
receive benefits as long as you reside in Japan. If you are not a U.S. or Japanese citizen and live in another country, you may not be
able to receive benefits. The restrictions on U.S. benefits are explained in Your Payments While You Are Outside The United
States(Publication No. 05-10137).

Appeals

If you disagree with the decision made on your claim for benefits under the agreement, contact any U.S. or Japanese Social Security
office. The people there can tell you what you need to do to appeal the decision.

The Japanese Social Security authorities will review your appeal if it affects your rights under the Japanese system, while U.S. Social
Security authorities will review your appeal if it affects your rights under the U.S. system. Since each country’s decisions are made
independently of the other, a decision by one country on a particular issue may not always conform with the decision made by the
other country on the same issue.

For more information

To file a claim for U.S. or Japanese benefits under the agreement, follow the instructions in "Claims for benefits" section.

To find out more about U.S. Social Security benefits or for information about a claim for benefits, contact any U.S. Social Security
office or call our toll-free number at 1-800-772-1213. If you live outside the United States, write to:

Social Security Administration
OlO—Totalization

P.O. Box 17769

Baltimore, Maryland 21235-7769
USA.

For more information about Japan's Social Security program, contact any branch office of a Japanese social insurance agency or:

If your most recent Social Security tax .
. Write to:
was paid to the:
Office for International Relations

Planning Div. Admin. Depart.

National Pension

Employee's Pension Insurance 1-2-2, Kasumigaseki
Chiyoda-ku, Tokyo 100-8945
Seamen's Insurance JAPAN

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Children-If unmarried, up to age 18 (age Children-

19 if in an elementary or secondary school
full time) or any age if disabled before age

22.

NP-No provision for children of retired
worker. A supplement is payable to a
Class I or Class Il disabled worker for
dependent children under age 18 (age 20
if disabled).

EPI-A supplement is payable to a retired
or disabled (Class I or Class II only) worker
for dependent children under age 18 (age
20 if disabled).

Survivors benefits

United States
Survivor benefits payable to the
following categories:
Widow or widower-Full benefit at full

Japan
Survivor benefits payable as follows:

NP-The deceased must be covered or

retirement age or at any age if caring for receiving a pension at the time of death

the deceased's entitled child under age 16 and have coverage credit for at least two-

(or disabled before age 22). Reduced
benefit as early as age 60 (or age 50 if
disabled) if not caring for child. Benefits
may be continued if remarriage occurs
after age 60 (or age 50 if disabled).

Divorced widow or widower-Same as
widow or widower if marriage lasted at
least 10 years.

Children-Same as for children of retired
or disabled worker.

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thirds of the period from age 20 to the
date of death.

Benefits payable to a dependent widow
who is caring for the deceased's child
under age 18 (age 20 if disabled). Widow's
benefit includes a supplement for
children.

A separate benefit payable to orphans
under age 18 (age 20 if disabled).

EPI-The deceased must be covered or
receiving a pension at the time of death
and have coverage credit for at least two-
thirds of the period from age 20 to the
date of death.

Benefits payable to a dependent widow
who is caring for the deceased's child
under age 18 (age 20 if disabled). Widow's.
benefit includes a supplement for
children.

If there is no widow caring for the
deceased's child, benefits may be paid to
another survivor of the worker in the
order of priority listed below.

. orphans

. childless widow

. widower

. parents age 55 or older

. grandchildren under age 18

wkwne

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Certificates For Employees

To establish an exemption from compulsory coverage and taxes under the Japanese system, your employer must request a
certificate of coverage (form USA/J 6) from the United States at this address:

Social Security Administration
Office of International Programs
P.O. Box 17741

Baltimore, Maryland 21235-7741
USA.

If preferred, the request may be sent by fax to (410) 966-1861. Please note this fax number should only be used for requesting
certificates of coverage.

No special form is required to request a certificate, but, the request must be in writing and provide the following information:

Full name of worker;

© Date and place of birth;

© Citizenship;

© Country of worker's permanent residence;

© US. Social Security number;

© Date of hire;

© Country of hire;

« Name and address of the employer in the U.S. and Japan;

© Date of transfer and anticipated date of return, and

e Astatement, signed by your employer, certifying whether or not you and all family members who live with you in Japan, are
covered by an employer-sponsored or other private health insurance plan while in Japan (see Note below).

In addition, your employer must indicate whether you remain an employee of the U.S. company while working in Japan or you
become an employee of the U.S. company’s affiliate in Japan. If you become an employee of an affiliate, your employer must
indicate whether the U.S. company has an agreement with the Internal Revenue Service under section 3121(|) of the Internal
Revenue Code to pay U.S. Social Security taxes for U.S. citizens and residents employed by the affiliate and, if yes, the effective date
of the agreement.

Your employer can also request a certificate of U.S. coverage for you over the Internet using a special online request form available
at www.socialsecurity.gov/coc. 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.

Note

In addition to retirement, disability and survivors benefits, Japanese Social Security taxes cover several other benefit programs
including Japan's health insurance program. If the employer or a self-employed person certifies the worker and all family
members who accompany the worker to Japan are covered by an employer-sponsored or other private health insurance plan
while in Japan, the worker and accompanying family members can be exempted from paying Japanese Social Security taxes
including contributions to Japan's health insurance program and cannot receive health care services or other benefits under the
Japanese health insurance system. If the employer or self-employed person does not certify that the worker and all family
members who accompany the worker to Japan are covered by an employer sponsored or other private health insurance plan
while in Japan, the worker and accompanying family members must pay Japanese Social Security taxes including contributions
for Japan's health insurance system.

To establish your exemption from coverage under the U.S. Social Security system, your employer in Japan must request a certificate
of coverage (form J/USA 6) from the local Japanese social insurance agency that collects your Social Security taxes in Japan.

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US.
© Sent you to work in the U.S. for more than
five years
US.
© Hired you in the U.S.
For a non-Japanese employer US.
For the Japanese government and you are a:
Japan
¢ Japanese national
U.S.
e US. national
You are self-employed and you:
U.S.
© Work only in the U.S.
US.

© Normally work in the U.S. but transfer your
business activity to Japan for five years or
less

Japan
© Work only in Japan

Japan
© Normally work in Japan but transfer your

business activity to the U.S. for five years
or less

If this table doesn't seem to describe your situation and you are:

a Write to the U.S. address in
* Working in the U.S. "Certificates for employees" section

for further information.

. Write to the appropriate Japanese
* Working in Japan address in "For more information"

section for further information.

Note

As the table indicates, a U.S. worker employed in Japan can be covered by U.S. Social Security only if he or she works for a U.S.
employer. A U.S. employer includes a corporation organized under the laws of the United States or any state, a partnership if at
least two-thirds of the partners are U.S. residents, an individual who is a resident of the U.S. or a trust if all the trustees are U.S.
residents. The term also includes a foreign affiliate of a U.S. employer if the U.S. employer has entered into an agreement with the
Internal Revenue Service under section 3121(l) of the Internal Revenue Code to pay Social Security taxes for U.S. citizens and
residents employed by the affiliate.

Certificate of coverage

A certificate of coverage issued by one country serves as proof of exemption from Social Security taxes on the same earnings in the
other country.

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Before the agreement, employees, employers and self-employed people could, under certain circumstances, be required to pay

International Programs - Totalization Agreement with Japan

Social Security taxes to both the United States and Japan for the same work.

Under the agreement, if you work as an employee in the United States, you normally will be covered by the United States, and you
and your employer will pay Social Security taxes only to the United States. If you work as an employee in Japan, you normally will

be covered by Japan, and you and your employer pay Social Security taxes only to Japan.

On the other hand, if your employer sends you from one country to work for that employer in the other country for five years or
less, you will continue to be covered by your home country and you will be exempt from coverage in the other country. For
example, if a U.S. company sends an employee to work for that company in Japan for no more than five years, the employer and

the employee will continue to pay only U.S. Social Security taxes and will not have to pay in Japan

Special rules apply to self-employed persons who, without the agreement, would have to pay Social Security taxes to both

countries (see the following table).

Summary Of Agreement Rules

The following table shows whether your work is covered under the U.S. or Japanese Social Security system. If you are covered under

U.S. Social Security, you and your employer (if you are an employee) must pay U.S. Social Security taxes. If you are covered under
the Japanese system, you and your employer (if you are an employee) must pay Japanese Social Security taxes. "Certificate of
coverage" section explains how to get a form from the country where you are covered that will prove you are exempt in the other

country.

Your work status
You are working in Japan:

For a U.S. employer who:

US.
© Sent you to work in Japan for five years or
less
Japan
© Sent you to work in Japan for more than
five years
Japan
© Hired you in Japan
For a non-U.S. employer Japan

For the U.S. government and you are a:

USS. (either Social Security or federal
retirement program

e US. national

Japan
© Japanese national
You are working in the U.S.:
For an employer in Japan who:
Japan
© Sent you to work in the U.S. for five years
or less

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Coverage and taxes

22