Download:
pdf |
pdfPreliminary Claims System (PCS)
Screen Package
Febryary 01, 2019
PCS Screen Package
February 01, 2019
Page 1 of 74
Table of Contents
1.
Individual Information – Individual applying on their own .......................................................................................................4
2.
Individual Information – Individual applying on their own – Privacy Act Statement.................................................................5
3.
Individual Information – Individual answering questions not applying on their behalf ............................................................6
4.
Individual Information – Not the correct customer ..................................................................................................................7
5.
Individual Information – Third party applying on behalf of individual ......................................................................................8
6.
Individual Information – Individual third party applying on behalf of customer .......................................................................9
7.
Individual Information – Organizational third party applying on behalf of customer ............................................................. 10
8.
Individual Information – Other third party applying on behalf of customer ........................................................................... 11
9.
Individual Information – Custodian or legal guardian applying on behalf of legally incompetent individual .......................... 12
10.
Individual Information – Custodian or legal guardian applying on behalf of legally competent customer .............................. 13
11.
Protective Filing – with one or more leads ............................................................................................................................. 14
12.
Protective Filing no lead – Yes ................................................................................................................................................ 16
13.
Protective Filing no lead – There is no previous protective filing date before today ............................................................... 17
14.
Person Information – Select “No” to add or update notice due to vision impairment ............................................................ 18
15.
Person Information – Select “Yes” to add or update notice due to vision impairment ........................................................... 20
16.
Person Information – Edit identity information ...................................................................................................................... 22
17.
Person Information – Edit identity information: add other name........................................................................................... 27
18.
Person Information – Edit identity information: add other name........................................................................................... 28
19.
Person Information – Edit identity information: edit other name & error messages .............................................................. 29
20.
Person Information – Edit citizenship information ................................................................................................................. 30
20. Person Information – Edit citizenship information: Add citizenship ........................................................................................... 31
20.1 Person Information – Edit citizenship information: Add citizenship ......................................................................................... 33
20.2 Person Information – Edit citizenship information: Add citizenship ......................................................................................... 34
23. Person Information – Edit contact information: U.S. primary phone number ............................................................................ 36
24. Person Information – Edit contact information: International primary phone number.............................................................. 39
24.1 Person Information – Edit contact information: Manage address ............................................................................................ 41
24.2 Person Information – Edit contact information: Manage address ............................................................................................ 42
25. Residence Address – Current mailing address is the same as residence address ........................................................................ 45
26. Residence Address – Current mailing address is different from residence address .................................................................... 46
27. Disability – “Yes” to all .............................................................................................................................................................. 49
28. Earnings – “Yes” to all ................................................................................................................................................................ 50
29. Earnings – “No” is selected ........................................................................................................................................................ 56
30. Insured Status............................................................................................................................................................................ 59
31. Children – No children ............................................................................................................................................................... 61
PCS Screen Package
February 01, 2019
Page 2 of 74
32. Children – Children is selected ................................................................................................................................................... 62
33. Supplemental Security Income – Yes to all ................................................................................................................................ 63
34. Supplemental Security Income - Do not wish to apply for SSI .................................................................................................... 67
35. Benefits Summary – Default view (table)................................................................................................................................... 68
36. Next Steps – Variations: file for all four benefit types ................................................................................................................ 71
37. Next Steps – Variations: set up an appointment for all four benefit types ................................................................................. 72
38. Next Steps – Variations: closeout for all four benefit types ....................................................................................................... 73
39. Next Steps – Variations: combination ........................................................................................................................................ 74
PCS Screen Package
February 01, 2019
Page 3 of 74
1. Individual Information – Individual applying on their own
PCS Screen Package
February 01, 2019
Page 4 of 74
2. Individual Information – Individual applying on their own – Privacy Act Statement
PCS Screen Package
February 01, 2019
Page 5 of 74
3. Individual Information – Individual answering questions not applying on their behalf
PCS Screen Package
February 01, 2019
Page 6 of 74
4. Individual Information – Not the correct customer
PCS Screen Package
February 01, 2019
Page 7 of 74
5. Individual Information – Third party applying on behalf of individual
PCS Screen Package
February 01, 2019
Page 8 of 74
6. Individual Information – Individual third party applying on behalf of customer
Individual third party includes: spouse, parent, child, step parent, other family members, friend, and other relatives
PCS Screen Package
February 01, 2019
Page 9 of 74
7. Individual Information – Organizational third party applying on behalf of customer
Organizational third party includes: government agency, non-profit organizational/legal aid group, health service agency/hospital,
nursing care facility, non-related third party such as attorney, friend, advocacy group, legal entities, and attorney representatives.
PCS Screen Package
February 01, 2019
Page 10 of 74
8. Individual Information – Other third party applying on behalf of customer
PCS Screen Package
February 01, 2019
Page 11 of 74
9. Individual Information – Custodian or legal guardian applying on behalf of legally
incompetent individual
PCS Screen Package
February 01, 2019
Page 12 of 74
10.Individual Information – Custodian or legal guardian applying on behalf of legally
competent customer
PCS Screen Package
February 01, 2019
Page 13 of 74
11. Protective Filing – with one or more leads
PCS Screen Package
February 01, 2019
Page 14 of 74
PCS Screen Package
February 01, 2019
Page 15 of 74
12.Protective Filing no lead – Yes
PCS Screen Package
February 01, 2019
Page 16 of 74
13.Protective Filing no lead – There is no previous protective filing date before today
PCS Screen Package
February 01, 2019
Page 17 of 74
14.Person Information – Select “No” to add or update notice due to vision impairment
PCS Screen Package
February 01, 2019
Page 18 of 74
PCS Screen Package
February 01, 2019
Page 19 of 74
15.Person Information – Select “Yes” to add or update notice due to vision impairment
PCS Screen Package
February 01, 2019
Page 20 of 74
PCS Screen Package
February 01, 2019
Page 21 of 74
16.Person Information – Edit identity information
PCS Screen Package
February 01, 2019
Page 22 of 74
PCS Screen Package
February 01, 2019
Page 23 of 74
PCS Screen Package
February 01, 2019
Page 24 of 74
Note: The values in the drop-down list are from states GRT.
PCS Screen Package
February 01, 2019
Page 25 of 74
Note: This is the drop list for “Birth Date Proof”.
Note: This is the drop list for “Birth Date Proof Type”.
PCS Screen Package
February 01, 2019
Page 26 of 74
17. Person Information – Edit identity information: add other name
Select name type: Full name
PCS Screen Package
February 01, 2019
Page 27 of 74
18. Person Information – Edit identity information: add other name
Select name type: Single name
PCS Screen Package
February 01, 2019
Page 28 of 74
19. Person Information – Edit identity information: edit other name & error messages
PCS Screen Package
February 01, 2019
Page 29 of 74
20.Person Information – Edit citizenship information
Default view
PCS Screen Package
February 01, 2019
Page 30 of 74
20. Person Information – Edit citizenship information: Add citizenship
“Yes” to U.S. citizenship, “Yes” to citizenship ended.
PCS Screen Package
February 01, 2019
Page 31 of 74
PCS Screen Package
February 01, 2019
Page 32 of 74
20.1 Person Information – Edit citizenship information: Add citizenship
“Yes” to U.S. citizenship, “No” to citizenship ended.
PCS Screen Package
February 01, 2019
Page 33 of 74
20.2 Person Information – Edit citizenship information: Add citizenship
Not a U.S. citizen
PCS Screen Package
February 01, 2019
Page 34 of 74
Note: The values in the drop-down list are from the historical country GRT.
PCS Screen Package
February 01, 2019
Page 35 of 74
23. Person Information – Edit contact information: U.S. primary phone number
PCS Screen Package
February 01, 2019
Page 36 of 74
PCS Screen Package
February 01, 2019
Page 37 of 74
Note: The values in the drop-down list are from the language GRT.
Note: The values in the drop-down list are from the language GRT.
PCS Screen Package
February 01, 2019
Page 38 of 74
24. Person Information – Edit contact information: International primary phone number
PCS Screen Package
February 01, 2019
Page 39 of 74
PCS Screen Package
February 01, 2019
Page 40 of 74
24.1 Person Information – Edit contact information: Manage address
Select existing addresses
PCS Screen Package
February 01, 2019
Page 41 of 74
24.2 Person Information – Edit contact information: Manage address
Add new addresses and verify address
PCS Screen Package
February 01, 2019
Page 42 of 74
Note: The values in this drop-down list are from the country GRT.
PCS Screen Package
February 01, 2019
Page 43 of 74
Note: The values in the drop-down list are from the states GRT.
PCS Screen Package
February 01, 2019
Page 44 of 74
25. Residence Address – Current mailing address is the same as residence address
PCS Screen Package
February 01, 2019
Page 45 of 74
26. Residence Address – Current mailing address is different from residence address
PCS Screen Package
February 01, 2019
Page 46 of 74
Note: The values in the drop-down list are from the country GRT.
PCS Screen Package
February 01, 2019
Page 47 of 74
Note: The values in the drop-down list are from the states GRT.
PCS Screen Package
February 01, 2019
Page 48 of 74
27. Disability – “Yes” to all
PCS Screen Package
February 01, 2019
Page 49 of 74
28. Earnings – “Yes” to all
PCS Screen Package
February 01, 2019
Page 50 of 74
PCS Screen Package
February 01, 2019
Page 51 of 74
PCS Screen Package
February 01, 2019
Page 52 of 74
PCS Screen Package
February 01, 2019
Page 53 of 74
Note: the year drop down from the table will be dynamic based on the person's date of birth.
PCS Screen Package
February 01, 2019
Page 54 of 74
Note: The values in the drop-down list is from the historical country GRT.
PCS Screen Package
February 01, 2019
Page 55 of 74
29. Earnings – “No” is selected
PCS Screen Package
February 01, 2019
Page 56 of 74
PCS Screen Package
February 01, 2019
Page 57 of 74
PCS Screen Package
February 01, 2019
Page 58 of 74
30. Insured Status
PCS Screen Package
February 01, 2019
Page 59 of 74
PCS Screen Package
February 01, 2019
Page 60 of 74
31. Children – No children
PCS Screen Package
February 01, 2019
Page 61 of 74
32. Children – Children is selected
PCS Screen Package
February 01, 2019
Page 62 of 74
33. Supplemental Security Income – Yes to all
PCS Screen Package
February 01, 2019
Page 63 of 74
Note: This is the resources dropdown list.
PCS Screen Package
February 01, 2019
Page 64 of 74
Note: This is the income dropdown list.
PCS Screen Package
February 01, 2019
Page 65 of 74
PCS Screen Package
February 01, 2019
Page 66 of 74
34. Supplemental Security Income - Do not wish to apply for SSI
PCS Screen Package
February 01, 2019
Page 67 of 74
35. Benefits Summary – Default view (table)
PCS Screen Package
February 01, 2019
Page 68 of 74
PCS Screen Package
February 01, 2019
Page 69 of 74
PCS Screen Package
February 01, 2019
Page 70 of 74
36. Next Steps – Variations: file for all four benefit types
PCS Screen Package
February 01, 2019
Page 71 of 74
37. Next Steps – Variations: set up an appointment for all four benefit types
PCS Screen Package
February 01, 2019
Page 72 of 74
38. Next Steps – Variations: closeout for all four benefit types
PCS Screen Package
February 01, 2019
Page 73 of 74
39. Next Steps – Variations: combination
PCS Screen Package
February 01, 2019
Page 74 of 74
| File Type | application/pdf |
| Author | Fujitsu |
| File Modified | 2019-02-12 |
| File Created | 2019-02-12 |