1st Party Internet Social Security Benefits Application (iClaim)

Social Security Benefits Application

Basic 29 Screen Package_ English iClaim_04062011

1st Party Internet Social Security Benefits Application (iClaim)

OMB: 0960-0618

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English iClaim Updated

Screen Package
Version 1.4





April 5, 2011



Table of Contents


1. Pages 4

1.1. ent001_Welcome 4

1.2. ent003_Welcome 5

1.3. ent004_Restart 6

1.4. ini002-r_Applicant Identification 7

1.5. ini003-1_Contact Information 8

1.6. ini003-1_Contact Information_Foreign 9

1.7. ini004-1_Birth and Citizenship 10

1.8. ini004-1_Birth and Citizenship_foreign citizen 11

1.9. ini005-1_01_Medicare Election Information 12

1.10. apn001-r1_Application Number 13

1.11. adi001-1_01_Other SSNs and Names 14

1.12. adi002-1_01_Disability 15

1.13. fam001-1_01_Marriage Information 16

1.14. fam001-1_01_Marriage Information_Yes 17

1.15. fam001-1_01_Marriage Information_No 18

1.16. fam002-1_02_Prior Marriages 19

1.17. fam002-1_02_Prior Marriages_add page_empty table 20

1.18. fam002-1_02_Prior Marriages_add page4 21

1.19. fam002-1_02_Prior Marriages_add_waddl questions 22

1.20. fam002-1_02_Prior Marriages_add page_Yes 23

1.21. fam002-1_02_Prior Marriages_add page_No 24

1.22. fam002-1_02_Prior Marriages_summary page 25

1.23. fam002-1_02_Prior Marriages_summary page_message 26

1.24. fam003-r1_Children 27

1.25. mil001-1_Military Details_initial state 28

1.26. mil001-1_Military Details_tableempty 29

1.27. mil001-1_Military Details_Period1 30

1.28. mil001-1_Military Details_Table9Row_NoWarning 31

1.29. mil001-1_Military Details_Table10Row_Warning 32

1.30. ear001-1-lag_Employer Details 33

1.31. ear001-1-lag_01_tableEmpty 34

1.32. ear001-1-lag_02_EmployerDetailEntry 35

1.33. ear001-1-lag_02_EmployerDetailEntry_Foreign Address 36

1.34. ear001-1-lag_03_table1Row 37

1.35. ear001-1-lag_05_table9Rows 38

1.36. ear002-lag_Self Employment 39

1.37. ear002-lag_workingCollapse_Self Employment 40

1.38. ear003-1-a_Supplemental Information 41

1.39. ear004_Total Earnings 42

ear004-d1-b_Total Earnings 45

1.40. ear005-1-a_Other Pensions/Annuities 46

1.41. wst000-1_Reduced Benefits 47

1.42. wst001-1-b_When to Start Retirement Benefits 48

1.43. wst001-1-e_When to Start Retirement Benefits 49

1.44. wst001-3-c_When to Start Retirement Benefits 50

1.45. wst001-3-d_When to Start Retirement Benefits 51

1.46. wst002-1_Direct Deposit Details 52

1.47. wst002-1_Direct Deposit Details w/Errors 53

1.48. bni001-1_Benefit Information 54

1.49. bni002-3_Health Insurance 55

1.50. rem001_Remarks 56

1.51. ovs001-r1-a_Overall Summary 57

1.52. snd001-r1_Send This Application 63

1.53. snd001-alternate 64

1.54. rec001-r1-a_Evidence and Receipt 65

1.55. wtn001-r1_Next Steps 71


2. Messages 72

2.1. msg005_GoToEstimator 72

2.2. msg010_Check the Information You Entered 73

2.3. msg027_We cannot process your request at this time 74

2.4. msg028_This service is not available at this time 75

2.5. msg045_Hours of Operation 76

2.6. msg051_We cannot Process your request 77

2.7. msg052_We cannot Process your request 78

2.8. msg152_Sign Off 79

2.9. Bank Info Msg - Where can I find this? 80



  1. Pages

    1. ent001_Welcome

    1. ent003_Welcome

    1. ent004_Restart

    1. ini002-r_Applicant Identification

    1. ini003-1_Contact Information

    1. ini003-1_Contact Information_Foreign

    1. ini004-1_Birth and Citizenship

    1. ini004-1_Birth and Citizenship_foreign citizen

    1. ini005-1_01_Medicare Election Information

    1. apn001-r1_Application Number

    1. adi001-1_01_Other SSNs and Names

    1. adi002-1_01_Disability

    1. fam001-1_01_Marriage Information

    1. fam001-1_01_Marriage Information_Yes

    1. fam001-1_01_Marriage Information_No

    1. fam002-1_02_Prior Marriages

    1. fam002-1_02_Prior Marriages_add page_empty table

    1. fam002-1_02_Prior Marriages_add page4

    1. fam002-1_02_Prior Marriages_add_waddl questions

    1. fam002-1_02_Prior Marriages_add page_Yes

    1. fam002-1_02_Prior Marriages_add page_No

    1. fam002-1_02_Prior Marriages_summary page

    1. fam002-1_02_Prior Marriages_summary page_message

    1. fam003-r1_Children

    1. mil001-1_Military Details_initial state

    1. mil001-1_Military Details_tableempty

    1. mil001-1_Military Details_Period1

    1. mil001-1_Military Details_Table9Row_NoWarning

    1. mil001-1_Military Details_Table10Row_Warning

    1. ear001-1-lag_Employer Details

    1. ear001-1-lag_01_tableEmpty

    1. ear001-1-lag_02_EmployerDetailEntry

    1. ear001-1-lag_02_EmployerDetailEntry_Foreign Address

    1. ear001-1-lag_03_table1Row

    1. ear001-1-lag_05_table9Rows

    1. ear002-lag_Self Employment

    1. ear002-lag_workingCollapse_Self Employment

    1. ear003-1-a_Supplemental Information

    1. ear004_Total Earnings


ear004-d1-b_Total Earnings

    1. ear005-1-a_Other Pensions/Annuities

    1. wst000-1_Reduced Benefits

    1. wst001-1-b_When to Start Retirement Benefits

    1. wst001-1-e_When to Start Retirement Benefits

    1. wst001-3-c_When to Start Retirement Benefits

    1. wst001-3-d_When to Start Retirement Benefits

    1. wst002-1_Direct Deposit Details

    2. bni001-1_Benefit Information

    1. bni002-3_Health Insurance

    1. rem001_Remarks

    1. ovs001-r1-a_Overall Summary







    1. snd001-r1_Send This Application

    1. rec001-r1-a_Evidence and Receipt







    1. wtn001-r1_Next Steps

  1. Messages

    1. msg005_GoToEstimator

    1. msg010_Check the Information You Entered

    1. msg027_We cannot process your request at this time

    1. msg028_This service is not available at this time

    1. msg045_Hours of Operation

    1. msg051_We cannot Process your request

    1. msg052_We cannot Process your request

    1. msg152_Sign Off

    1. Bank Info Msg - Where can I find this?

Page 1 of 65

Last Updated: 4/5/2011 Version 1.4


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