ePFT - Respondent Type 3 (ex: Attorney Representatives)

Screens for the Online Appointment Tool - Third Party Path

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Important - The Third-Party Path follows the identical flow and screen description as the path for the
first party users, except for an additional screen (screen # 8 part of this package). The additional screen
requests contact information of the individual providing the information for the potential claimant.
Individuals can distinguish these screens by looking at the message located at the top of the pages (e.g.,
“For the person you are assisting…” Both, the first and third party/Assistor paths are also available to
mobile users.

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 the “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.

Screens for the Online Appointment Tool - Third Party Path

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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

We ask individuals to indicate who they are answering the questions about. If the individual
selects any option other than “Yourself” or “Someone else who is with you as you answer these
questions”, the system presents the third-party/Assistor path.
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 the personal contact information (name, phone number, and mailing
address) for the person they are assisting 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

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 the personal contact information for the person they are assisting and selecting
next, the individual is asked to provide the date of birth and social security number of the person
they are assisting. 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.

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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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Screens #8 Information about You (Parent/Spouse/Someone Else)

This screen is to collect information about the individual using the tool. We request this
information to contact the individual that requested the appointment (if needed) and evaluate if
they are the parent of a child or legal representative of an incompetent adult whose care they are
responsible for. Their response helps us to determine to who address the appointment mail
notices and determine who is receiving the appointment (e.g., parent, legal guardian, etc.,).

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Screen #9 Language Preference

This screen provides a scroll down with 89 languages and an option for “other” for the individual
to indicate the language preference for the person they are assisting. 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 #10 Special Circumstances

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

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Screen #11 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 #11 (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 #12 Information submitted and Alert

Individuals that selected the option #2 (“A minor child…” or “An incompetent adult whose
care…”) will receive the message above providing the specific dates that an application must be
submitted by to avoid losing benefits.
All other individuals will receive the message below with information about the appointment
request.

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Screens #12 (Cont.) Information submitted and Alert

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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Screens #13 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. Individuals 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 #14 Email Confirmation Messages

Once the information is transmitted to SSA, and if an email is provided, the system will release
an email to the individual who provided the information to acknowledge the submission. The
email will contain the language above providing information about the appointment and time
frames for filing an application.
The system will also email the potentially eligible individual to alert them of the appointment
request. The email sample is shown below.