Current SSA-820-APP (submittable PDF)

SSA820 Online Application
Screen Package
June 25, 2021

SSA820 Screen Package

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Contents
Application Landing Page: ................................................................................................................................................3
Email and Password Landing Page: ....................................................................................................................................4
Email Confirmation Page: ..................................................................................................................................................5
First Email: ........................................................................................................................................................................6
Password Confirmation: ..................................................................................................................................................7
SSA820 Cover Sheet: .......................................................................................................................................................8
SSA820 Adobe Form: .......................................................................................................................................................9
Attachment Fields: .........................................................................................................................................................15
Example of Conditional Required Fields: ......................................................................................................................16
Signature:.......................................................................................................................................................................17
Completed Signature:........................................................................................................................................................18
SSA Adobe Forms Completion Page: .....................................................................................................................................................................19
Final Email: .................................................................................................................................................................................................................20
Password Request Page:..........................................................................................................................................................................................21
SSA820 Completed Form:........................................................................................................................................................................................22

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Application Landing Page:

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Email and Password Landing Page:

On this page, the claimant sets the password that will be used to access the form.

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Email Confirmation Page:

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First Email:

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Password Confirmation:

The claimant must provide the password to access the form.

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SSA820 Cover Sheet:

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SSA820 Adobe Form:

Red asterisks notate a required field. Note that some required fields are conditional, based upon how the
prior question was answered. Please see page 16 for an example.

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SSA820 Adobe Form:

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SSA820 Adobe Form:

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SSA820 Adobe Form:

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SSA820 Adobe Form:

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SSA820 Adobe Form:

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Attachment Fields:

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Example of Conditional Required Fields:

The SSA820's questions are based on conditional values. The example displayed above shows that by
selecting "YES" to question 1, question 2 is not available to enter information in, and the user can move
onto question 3.
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Signature:

By clicking in the Signature field the user can type their name to sign the document.

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Completed Signature:

Signature now appears on the form with the date it was signed appearing below signature. If all required fields
are filled out, user can "Click to Sign".

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SSA820 Adobe Form Completion Page:

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Final Email:

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Password Request Page:

In order to view the completed form, the user must enter their pre-established password .

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SSA820 Completed Form:

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SSA820 Completed Form:

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SSA820 Completed Form:

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SSA820 Completed Form:

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SSA820 Completed Form:

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SSA820 Completed Form:

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SSA820 Completed Form:

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