1st Party Internet Social Security Benefits Application (iClaim) - Domestic Applicants

iClaim “Marriage” Application Modified Screens
Modified Screen #1: Welcome Page for disability (DIB)

The screen was modified slightly. Applicants receive this screen after selecting the type of claim they
are applying for. In this case when the applicant selects “Apply for Disability” from any entry point,
they are directed to this screen. The formatting was changed to improve the look of the screen and to
modify the language applicable to the i3368 form. The change also applies to our welcome pages for
RIB, DIB, and Medicare.

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OISP/OAESP

Modified Screen #2
Who is Completing this Application?

We added functionality to this screen to make the question more dynamic. If the applicant is a first party
(i.e. selects the 1st and 2nd option) then the “blind or visual impaired question is displayed. If the
applicant is a 3rd party, no additional question is displayed.

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Modified Screen #3
Information About You

We moved this question from another page within iClaim in order to determine (up front) if the claimant
meets the disability requirements and to differentiate individuals filing for other benefits as well
(RIB/DIB).

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Modified Screen #3
Information About You

If the claimant responds to “yes” to the “expected to end in death” question, a message displays to
encourage contact with the local office.

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Modified Screen #4
Contact Information

A new information bar was added to the top of all the disability screens to indicate the four steps involved with
the online disability process.

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Modified Screen #5
Ability to Communicate in English and Language Preference

Added questions
from i3368

Ability to communicate in English – Currently there is no questions about ability to communicate in English on
this screen. We added these questions into the iClaim path (they are in the i3368) to make the transition less
confusing and facilitate the information propagation into the i3368 form.
Language preferences – We currently display a drop down for the claimant to select the language preference.
We added a note under the language preference to clarify the information is used for communication purposes

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Modified Screen #6
Re-entry Number

This page was previously shown as the “Application Number” screen. We changed the current term
“Application Number” to “Re-entry Number” since this number will now be used to allow the user to
return either to the iClaim application or to the i3368 medical form.

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Modified Screen #6
Re-entry Number (SSI Definition display)

We currently offer a link to “click” for more information about the SSI program. We changed the link to
a “hovering informational display.” Now, applicants can hover over the underlined language and have
the SSI information automatically displayed, rather than clicking and being taken to another page.

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Modified Screen #7
Return to Saved Application Process

We changed the current term “Application Number” to “Re-entry Number” since this screen will now be
displayed to all applicants who are returning either to the iClaim application or to the i3368 medical
form. We made this change based on recommendations to differentiate from the application and the
form.

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Modified Screen #8
Children

We currently don’t have a leading question to determine if the applicant has children, therefore we
automaticaly ask for the children information. We added new functionality within the leading question
to avoid asking the subsequent information if unnecessary. If the applicant answers “yes” to the first
question then the following conditional questions are displayed. Presently, we have the same language
and information shown above; the change was made only to make it more dynamic.

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Modified Screen #9
Supplemental Information

Removed

We currently ask for information about corporate work. We removed the Corporate Officer questions because
of a recent policy change.

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OISP/OAESP

Modified Screen #10
Ability to Work

Removed

We currently ask for “The Disability Conditions” a claimant has (e.g. broken leg, depression, etc.,); however,
the “description of the condition” is not needed as part of the application because the i3368 asks the same
information. We removed this question from this page and the paper application to eliminate duplicate data
entry.

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Modified Screen #11
Authorization

Removed

We currently present a “yes” or “no” option for the following statement “I authorize disclosure of medical
information”; however, the SSA 827 collects the same information. We removed this question from this page
and the paper application to eliminate duplicate data entry.

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Modified Screen #12
Review and Sign

We currently display this as “review and submit” at the top of the screen (next to remarks). The term is
now “review and sign.” We made this change to make a smooth transition to the next page which is the
starting point of the i3368.

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Modified Screen #13
Electronic Signature

The current language in this page refers to the disability application only. We updated the language on this page
to reflect the connection of the iClaim and the i3368 form. We also changed the button at the bottom of the page
“Accept and Continue to Step 2” so that applicants realize that they are done with this portion of the application,
but additional steps remain.

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New Screen #14
Transition from Spanish iClaim to i3368

Spanish applicants receive this page if they indicate they don’t want to proceed with the
i3368 in English.

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