mySSA Advance Designation of Representative Payee Screen Package - Revised

SCREEN PACKAGE DOCUMENT
SECTION 201, ADVANCE DESIGNATION OF
REPRESENTATIVE PAYEE FOR MYSSA

Screen Package Document – Advance Designation of Representative Payee for mySSA

Table of Contents
1.

Screen Package Document Version Information ........................................................................................................ 3

2.

Screen Designs and Component Descriptions ............................................................................................................ 4

2.1.

My Social Security Landing Page ................................................................................................................................. 4

2.2.

About Advance Designation ........................................................................................................................................ 6

2.3.

Lead-In Question ......................................................................................................................................................... 7

2.4.

Adding Advance Designees ......................................................................................................................................... 9

2.1.

Reviewing Advance Designation ............................................................................................................................... 11

2.2.

Receipt ...................................................................................................................................................................... 15

3.

Appendix A - UXG Contact Information for Analysts, Developers and Others ......................................................... 16

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Screen Package Document – Advance Designation of Representative Payee for mySSA

1. Screen Package Document Version Information
The first release of this document as a project deliverable is numbered 1.0.
Subsequent revisions are numbered 1.1, 1.2, 1.3, etc. Content revisions are listed below with corresponding page
numbers.
Version
Number
1.3

OPPM/DUEA/UXG

Date
September 26,
2019

Content Revisions
Author of initial release and all revisions – Yulia Wentling and Kai Wong

Page
#
pp. 9-12

3

Revised
by
N/A

Screen Package Document – Advance Designation of Representative Payee for mySSA

2. Screen Designs and Component Descriptions
2.1.

My Social Security Landing Page

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Screen Package Document – Advance Designation of Representative Payee for mySSA

A user can access the Advance Designation of Representative Payee application from the teaser placed at the my Social
Security landing page.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

2.2.

About Advance Designation

A user can review information about advance designation of a representative payee before proceeding.

NOTE: Once a user accesses the Advance Designation of Representative Payee application, a footer as shown below
displays.

The “OMB No.0960-NEW” is a hyperlink to the Paperwork Reduction Act as this is how the UEF is designed and standard
to mySSA.
The user has the option to print the Paperwork Reduction Act and the Privacy Act Statement.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

2.3.

Lead-In Question

A user accessed the Advance Designation of Representative Payee application.

If the user selects “Yes”, he or she will continue with entering advance designation information.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

If the user selects “No,” he or she will be advised on how to designate at a later time. A link labeled “contact us” will
take the user to a prominent help page at https://www.ssa.gov/myaccount/help/.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

2.4.

Adding Advance Designees

The user can add designees by selecting the “Add Designee” button.

The help link explains the term Order of Priority.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

The “Add Designee” button brings up a lightbox where the user can enter the advance designee’s information.

Providing the relationship is optional, but the user must respond to the “Relationship” field. “No response” is the option
the user selects when he or she does not want to provide the relationship. When the user selects “Other” from the
Relationship dropdown, he or she must enter a relationship.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

2.1.

Reviewing Advance Designation

After the user provides an advance designation, they will be able to review the list of advance designees. From here, the
user can update the designee information, delete one or all designees, and change the order of priority.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

To update designee information, the user selects the “Edit” button, a lightbox displays with the designee’s “Name”,
“Phone”, and “Relationship” pre-filled.

To change the order of priority, the user selects the “Change Order of Priority” button.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

To delete a designee, the user selects the “Delete” button. The following confirmation message displays.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

To delete all designees at once, the user selects the “Delete All” button. The following confirmation message displays.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

2.2.

Receipt

The user can print a read-only confirmation of his or her selections. Below is a sample of the receipt showing the
designees on record.

If the user chooses not to provide advance designation or deletes all of his or her designees, the receipt will indicate this.

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Screen Package Document – Advance Designation of Representative Payee for mySSA

3. Appendix A - UXG Contact Information for Analysts, Developers and Others
For information about any of the content included in this design specifications document, contact the User Experience
(UX) Lead for this product.
Name

Product Role

Email

Phone

Specialized Project
Knowledge

Dave Bell

UXG Technical
Advisor

David.Bell@ssa.gov

(410) 966-4248

User Research, Design, UX
Mgmt

Yulia Wentling

UX Lead

Yulia.Wentling@ssa.gov

(410) 265-4607

User Research, Design, UX
Education

Kai Wong

UX Designer

Christopher.K.Wong@ssa.gov

(410) 265-4690

User Research, Design

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SSA will insert the following revised Privacy Act & PRA Statements into the
form as soon as possible:
Privacy Act Statement
Collection and Use of Personal Information

Section 205(j) of the Social Security Act, as amended, allows us to collect this
information. Furnishing us this information is voluntary. However, failing to provide all or part
of the information may prevent us from selecting the representative payee(s) you designate to act
on your behalf.
We will use the information you provide to update and maintain your representative payee(s).
We may also share the information for the following purposes, called routine uses:
•

To third party contacts, where necessary, to establish or verify information provided
by representative payees or representative payee applicants; and

•

To contractors and other Federal Agencies, as necessary, for the purpose of assisting
us in the efficient administration of our programs. We will disclose information
under this routine use only in situations in which we may enter into a contractual or
similar agreement to obtain assistance in accomplishing an SSA function relating to
this system or records.

In addition, we may share this information in accordance with the Privacy Act and other Federal
laws. For example, where authorized, we may use and disclose this information in computer
matching programs, in which our records are compared with other records to establish or verify a
person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice(s)
(SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on
October 31, 2019, at 84 FR 58422. Additional information, and a full listing of all our SORNs,
is available on our website at www.ssa.gov/privacy.

Paperwork Reduction Act Statement - This information collection meets the requirements of
44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not
need to answer these questions unless we display a valid Office of Management and Budget
(OMB) control number. We estimate that it will take about 6 minutes to read the instructions,
gather the facts, and answer the questions. Send only comments regarding this burden estimate
or any other aspect of this collection, including suggestions for reducing this burden to: SSA,
6401 Security Blvd, Baltimore, MD 21235-6401.