ePFT - Respondent Type 1 (ex: Potential Applicants)

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Screen #1 – SSA.gov Landing page

Individuals visiting the SSA website to learn about Supplemental Security Income (SSI)
payments will be provided with a description of the SSI program and information about how to
file an application. In the informational section, individuals will be able to access the link
“Request an Appointment to File for Benefits” which will direct them to this “Landing Page”
shown above. This page informs individuals about the information needed prior to accessing the
online tool, the process for the request, and what to expect next once the information is
submitted.

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Screen #2 – Welcome/Starting Page

This is the “Starting page” where individuals receive information about the process. It informs
them that we may use the date of this request as their date of the application if they submit the
requested information and keep an appointment to file an application for benefits. The page also
offers links to the Frequently Asked Questions (FAQ), the Terms of Service (ToS), and the
Privacy Act (PA) statement. The FAQ link directs individuals to a SSA.gov page where
individuals can find different SSA topics, which includes information about appointments and
ways to contact us to reschedule an appointment when needed.
Individuals selecting the ToS link receive the pop-up message below.

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Screen #2 – (Cont.) Welcome/Starting Page
The ToS link informs individuals of various privacy and security aspects before the individual
enters the Government information system. The ToS acknowledges that we may monitor activity
within the online system. Individuals can either select “Back” to go back to the online tool, or
“Exit” to leave the tool.
The pop-up message also provides a direct link to SSA’s Internet Privacy Policy that explains the
agency’s online information practices.
Individuals selecting the PA statement link will receive the message below.

Individuals must select the link and view the PA statement before continuing, otherwise they will
receive the following alert:

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Screen #3 Selecting path for users

#1
#2
#3
#4
#5

We ask individuals to indicate who they are answering the questions about. If they select option
#1 “Yourself” or option #4 “Someone else who is with you as you answer these questions”,
individuals will continue the path for “First-Party users” (see screen #4). A first party user is an
individual who can sign an application on their own behalf. If the individual selects any other
option, the system presents the third-party/Assistor path. Although individuals making the
request for their child or for an incompetent adult whose care they are responsible for (option #2)
are also considered “First-Party users” as they might be able to sign the benefit application on the
claimant’s behalf, for the purpose of the description of this online tool, we include them on the
“Third-Party/Assistor Screens” package as it follows the same pathing for questions and format.
All fields with an asterisk (*) are mandatory fields and individuals must enter a response in order
to proceed to the next screen. If an individual does not enter or select a response, the system
provides an alert for individuals to take action and correct the information.

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Screen #4 Personal Information

Individuals must provide their personal contact information (name, phone number, and mailing
address) in order to submit their appointment request and receive an appointment confirmation
via mail. If an individual voluntarily provides an email address, we will email the appointment
confirmation as well.

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Screen #4 (Cont.) Personal Information – Alerts

Individuals who do not provide all the required information will receive an alert prompting them
to either enter the missing information or to enter the information in the proper format. For
example, phone number must be numeric and 10 digits, and the zip code must match the city and
state based on the postal service directory. At any point, individuals can choose to exit the tool
by selecting the “Exit” button. To ensure that the individual does want to exit the tool, the system
provides the following alert.

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Screens #5 Date of Birth and # 6 Social Security Number

Upon entering their personal contact information and selecting next, the individual is asked to
provide their date of birth and social security number. We require this information to establish
the appointment under the correct record and to alert us if there are special internal indicators
that need further evaluation. In addition, we use the provided date of birth to determine if the
individual is under the age of 13 years old to ensure compliance with the Children’s Online
Privacy Protection Act (COPPA) and OMB M-03-22 guidelines. Individuals under the age of 13
who attempt to use this tool will receive the following alert to contact us for additional
assistance.

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Screen #7 Disability Information

The Supplemental Security Income (SSI) program provides monthly payments to certain adults
and children with a disability or blindness, and individuals age 65 and older without a disability.
Therefore, we request individuals to indicate if they have a disability or if they are blind. If they
select “Yes” to the first question, the system presents the third question to provide us with an
estimated date of when the condition began. This information, along with the date of birth, helps
us to determine the type of appointment needed (e.g., aged, adult, or child appointment). In
addition, we provide a message about the option to request special notices for those with a visual
impairment.
Individuals selecting “No” to the first two questions receive the following alert advising them of
the SSI eligibility requirement. The alert does not prevent individuals from continuing to request
an appointment, as individuals are able to file an application to obtain a formal determination
from SSA about whether they may be entitled to benefits.

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Screen #8 Language Preference

This screen provides a scroll down with 89 languages and an option for “other” for the individual
to indicate their language preference. We request information about the language preference for
both speaking and reading. We use the information about the speaking language preference to
provide interpreters during the appointment interview. We use the information about reading
language preference to provide reading materials (if available) about our programs and certain
notices.

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Screen #9 Special Circumstances

This screen offers the option for individuals to choose from a list of special circumstances that
may apply to them. We use this information to provide either expedited appointments or
additional assistance as needed during the appointment interview.

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Screen #10 Review and Submit

This screen provides the opportunity for the individual to review all the provided information
prior to submission. If individuals need to correct any information, they can go back to the
previous pages to edit the answers.

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Screen #10 (Cont.) Review and Submit

If the information is correct and no changes are needed, individuals can agree with the electronic
signature agreement and select “Submit” to transmit the information to us. Individuals must
agree with the electronic signature agreement to submit the information, otherwise they will
receive an alert message.

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Screen #11 Information submitted and alert

After the individual submits the requested information, and the information passes certain
internal checks, the system displays this screen to inform the individual that SSA has received
the information. This screen also provides the specific date the individual submitted the
appointment request and the dates that an application must be submitted by to avoid losing
benefits.
If the information provided does not pass the internal checks, the system provides the following
alert informing the individual that we cannot process the request and they can call us.

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Screen #12 Alert – Online Tool Unavailable or Tool shutting down – 15 minutes

Our systems undergo daily maintenance during certain timeframes. During this “downtime”, our
systems may be interrupted and unavailable. Individual trying to use the tool during the
“downtime” will receive the message above.
Individuals attempting to use this online tool within 15 minutes of the “downtime” will receive
the screen below to alert them about the system interruption.

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Screen #13 Email Confirmation Message

Once the information is transmitted to SSA, and if an email address was provided, individuals
will receive an email confirmation with the information shown above.