Request for Hearing By Administrative Law Judge--Internet Version (i501)

Abandoned iAppeals Application – Final Screens

December 21, 2018

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A. Section: Entry, Restart, and Exit Pages
1. Wlcm001* – Getting Ready

*This is the screen identifier from SSA’s ApPages documentation for the existing iAppeals Revitalization/Attachment
Utility application.

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2. – Terms of Service

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3. - Return to a Saved Appeal 1st Party (was Rtrn001 - Return to a Saved Appeal)

4. - Return to a Saved Appeal 3rd Party (was Rtrn001 - Return to a Saved Appeal)

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5. – Save and Exit – 1st Party (was Exit 001 – Save and Exit)

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6. – Save and Exit – 3rd Party (was Exit 001 – Save and Exit)

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B. Section: Identification Pages
7. Rtry001-01 – Reentry Number – 1st Party

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8. Rnty001-3 – Reentry Number - 3rd Party

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9. Frmc001 - Preparer, Identification 3rd Party: Form Completer: Preparer’s Info

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10. Appd001-1 - Your Information 1st Party: Applicant Information

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11. Appd001-3 - Applicant Information 3rd Party: Applicant Information

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12. Rpnp001-1 – Representative – 1st Party

13. Rpnp001-3 – Representative – 3rd Party

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14. Appl001hr-1 Appeal Request 1st Party: Request for Hearing

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15. Appl001hr-3 Appeal Request 3rd Party: Request for Hearing

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16. Appl001rec-1 - Appeal Request 1st Party: Request for Reconsideration

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17. Appl001rec-3 - Appeal Request 3rd Party: Request for Reconsideration

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18. Cfid001-1 - Who Are You? 1st Party: Confirm Your Identity

19. Cfid001-3 - Who Are You? 3rd Party: Confirm Your Identity

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20. Cnti001-1 - Someone We Can Contact 1st Party: Contact Information

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21. Cnti001-3 - Someone We Can Contact 3rd Party: Contact Information

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C. Section: Medical Pages
1. Cicd001-1 – Medical Conditions – 1st Party Change in Medical Conditions

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2. Cicd001-3 – Medical Conditions – 3rd Party Change in Medical Conditions

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3. Nmed001-1 - Medical Treatment 1st Party: Medical Treatment

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4. Nmed001-3 - Medical Treatment 3rd Party: Medical Treatment

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5. Doho001-1 – Doctors and Hospitals – 1st Party

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6. Doho001-3 – Doctors and Hospitals – 3rd Party

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7. Doct002-1 – Doctor or Healthcare Provider Details – 1st Party

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8. Doct002-3 – Doctor or Healthcare Provider Details – 3rd Party

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9. Hosp002-1 - Hospital or Clinic Details 1st Party: Specific Hospital Detailed Information

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10. Hosp002-3 - Hospital or Clinic Details 3rd Party: Specific Hospital Detailed Information

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11. Test001-1 – Tests – 1st Party

12. Test001-3 – Tests – 3rd Party

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13. Test002-1 - Test Details 1st Party: Specific Test Detailed Information

14. Test002-3 - Test Details 3rd Party: Specific Test Detailed Information

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15. Medi001-1 – Medicines– 1st Party

16. Medi001-3 – Medicines – 3rd Party

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17. Medi002-1 - Medicine Details 1st Party: Specific Medicine Detailed Information

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18. Medi002-3 Medicine Details 3rd Party: Specific Medicine Detailed Information

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19. Othr001-1 - Other Medical Information 1st Party: Other Medical Records

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20. Othr001-3 - Other Medical Information 3rd Party: Other Medical Records

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21. Othr002-1 - Details of Other Medical Information 1st Party: Details of Other Medical Information

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22. Othr002-3 - Details of Other Medical Information 3rd Party: Details of Other Medical Information

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D. Section: Activities/Training

1. Actv001-1 - Activities 1st Party: Activities

2. Actv001-3 - Activities 3rd Party: Activities

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3. Wetr001-1 - Work and Education 1st Party: Work, Education & Training

4. Wetr001-3 Work and Education 3rd Party: Work, Education & Training

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5. Voct001-1 - Vocational Rehabilitation 1st Party: Vocational Rehabilitation

6. Voct001-3 - Vocational Rehabilitation 3rd Party: Vocational Rehabilitation

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E. Section: Review and Submit Pages
1. Rmks001-1 - Remarks 1st Party: Remarks

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2. Rmks001-3 - Remarks 3rd Party: Remarks

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3. Mdrf001-1 - Medical Release 1st Party: Medical Release Form

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4. Mdrf001-3 - Medical Release 3rd Party: Medical Release Form

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5. Revw001-1 – Summary - 1st Party

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6. Revw001-3 – Summary – 3rd Party

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7. Flup001 – Attach Files

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8. Conf001-1 - Confirmation 1st Party: Application Submission Confirmation

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9. Conf001-3 - Confirmation 3rd Party: Application Submission Confirmation

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10. Conf001-3-Rep Confirmation 3rd Party - Appointed Representative: Application Submission
Confirmation

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11. Rcpt001 – Receipt

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12. Covr001 - Cover Sheet Cover Sheet

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Section: Lightboxes
1. – Checklist Help Pop-up

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2. – Re-entry Number Help Pop-up

3. – Forgot or Lost Re-entry Number Help

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