I4547 (internet version)

The Advance Designation screen will appear at the end of the iClaim pathway for filers who do
not have a representative payee. The screen will provide a “yes” or “no” option.

Advance Designation – “No, Do Not Provide AD Now”

Advance Designation – “Yes, Provide AD Now”
(Screen split into 3 images below)

Providing “relationship” is optional, but the user must provide an answer to this field. “No
response” is an option to select if the user does not want to provide relationship.

Advance Designation – *“Restart – AD No Longer Applies”

Overall Summary – “No, Do Not Provide AD Now”

Overall Summary– “Yes, Provide AD Now”

Overall Summary – *“Restart – AD No Longer Applies”

* “Restart – AD No Longer Applies” screen provides information to an iClaim user in the
following possible scenario:
•
•
•

The iClaim user is eligible to see the Advance Designation option screens when
completing the iClaim, but leaves the claim without submitting it.
Upon re-entry into iClaim, the iClaim user now has a representative payee and is no
longer eligible to see the Advance Designation option screens.
iClaim will remove the Advance Designation option screens, along with any information
previously input by the filer, and will display this screen instead. The language on this
screen is intentionally broad because iClaim is not allowed to disclose information from
our records to the iClaim user, including the presence of a newly selected representative
payee.

The final screens in the mock-up show how the responses will display in the iClaim summary,
where the applicant will sign. The iClaim receipt is the same screen as the summary, but
without the signature agreement.