Mock-Up of the Revised MSSICS Screens

MSSICS MAILING/PAYMENT ADDRESS ADDR

SSS-SS-SSSS SSSSS SSSSSSSSSS TRANSFER TO: XXXX

ADDR: PPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPP

PPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPP

CITY: PPPPPPPPPPPPPPPPPPPPPP STATE: PP ZIP: PPPPP

FOREIGN COUNTRY: PPPPPPPPPPPPPPPPPPPPPP POSTAL ZONE: PPPPPPPPPPPPPPP

CONSULAR CODE: PPP STATE/COUNTY CODE: 99999X

DOMESTIC PHONE NO: PPP PPP PPPP FOREIGN PHONE NO: PPPPPPPPPPPPPPP

PHONE INFO: XXXXXXXXXX

EXPLAIN C/O ADDRESS: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

SELECT DIRECT DEPOSIT CHOICE: 9

1=BANK NO: PPPPPPPPP ACCT TYPE (C/S): P ACCT NO: PPPPPPPPPPPPPPPPP

2=ENROLL IN DIRECT EXPRESS 3=NO DIRECT DEPOSIT

SELECT NOTICE OPTION: 9

1=REGULAR 3=REGULAR WITH FOLLOW-UP PHONE CONTACT

2=CERTIFIED 4=BRAILLE

REMARKS (Y): P