List of Disability Welfare Application Forms
For those applying for Disability Welfare services for the first time or those updating the validity period of the services, submission of necessary documents is required.
Regarding the draft service usage plan, there are two types: the "Service Usage Plan" created by the local planning consultation support office, and the draft service usage plan "Self-Plan" created by the individual or others. Please submit either one.
If you have any questions about the procedures, please contact the Disability Welfare Division.
List of Documents for Users
Documents required for new service applications, renewals, etc.
In the case of renewal, we will send the necessary documents one month before the expiration date of the recipient certificate.
- Application Form for Nursing Care Benefits and Training Benefits, etc. (PDF 277.5KB)
- Application Form for Nursing Care Benefits and Training Benefits, etc. (Word 110.0KB)
- Application Form for Nursing Care Benefits and Training Benefits, etc. (Sample) (PDF 428.2KB)
Please submit if you have created your own usage plan.
Documents required for changes in benefits, services, etc.
- Application Form for Nursing Care Benefits and Training Benefits, etc. (PDF 277.5KB)
- Application Form for Nursing Care Benefits and Training Benefits, etc. (Word 110.0KB)
- Application Form for Nursing Care Benefits and Training Benefits, etc. (Sample) (PDF 428.2KB)
Please submit if you have created your own usage plan.
Documents Required for Changes to Name, Address, etc.
It is possible to apply by either method.
(1) Submit the Notification of Application Content Change to the Disability Welfare Division. (Mail submissions accepted)
- Notification of Application Content Change (PDF 93.0KB)
- Notification of Application Content Change (Word 50.5KB)
(2) Scan the QR code below or click the site name to apply electronically through the dedicated site.
Documents Required for Reissuance
It is possible to apply by either method.
(1) Submit the Application Form for Reissuance of Beneficiary Certificate to the Disability Welfare Division. (Mail submission is acceptable)
- Application Form for Reissuance of Beneficiary Certificate (PDF 95.8KB)
- Application Form for Reissuance of Beneficiary Certificate (Word 49.5KB)
(2) Scan the QR code below or click the site name to apply electronically through the dedicated site.
Others (Planning Consultation Requests, Limit Management)
- Plan Consultation Support Request (Change) Notification Form (PDF 76.0KB)
- Plan Consultation Support Request (Change) Notification Form (Word 38.5KB)
- User Burden Limit Management Office Request Notification Form (PDF 31.3KB)
To view the PDF file, you need "Adobe(R) Reader(R)". If you do not have it, please download it for free from Adobe website (new window).
This page is managed by the Welfare Department Disability Welfare Division
2111 Higashi-Naganuma, Inagi City, Tokyo 206-8601
Phone number: 042-378-2111 Fax number: 042-378-5677
Contact the Disability Welfare Division, Welfare Department of Inagi City