Mock-up MCS Screen for Direct Express

MCS Screen Mockup.doc

Application for Mother's of Father's Insurance Benefits 20CFR 404.339-404.342; 20CFR404.601-404.603

Mock-up MCS Screen for Direct Express

OMB: 0960-0003

Document [doc]
Download: doc | pdf

Current CADR Screen:


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2345678901234567890123456789012345678901234567890123456789012345678901234567890

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C

MCS CLAIMANT MAILING ADDRESS CADR SC90

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NH: SSSSSSSSS SSSSS SSSSSSSSSS CL: SSSSSSSSS SSSSS SSSSSSSSSS

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*ADDRESS 1: PPPPPPPPPPPPPPPPPPPPPP ADDRESS 2: PPPPPPPPPPPPPPPPPPPPPP

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ADDRESS 3: PPPPPPPPPPPPPPPPPPPPPP ADDRESS 4: PPPPPPPPPPPPPPPPPPPPPP

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*CITY: PPPPPPPPPPPPPPPPPPPPPP STATE: PP ZIP: PPPPP

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STATE & COUNTY CODE: PPPPPP COUNTY: XXXXXXXXXXXXXXX

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COUNTRY: PPPPPPPPPPPPPPPPPPPPPP CONSULAR CODE: PPP

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FOREIGN POSTAL ZONE: PPPPPPPPPPPPPPP

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DIRECT DEPOSIT ROUTING TRANSIT NUMBER: 999999999 ACCOUNT TYPE (C/S): A

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DEPOSITOR ACCOUNT NUMBER: 99999999999999999

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DOMESTIC PHONE: PPPPPPPPPP FOREIGN PHONE: PPPPPPPPPPPPPPP

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TRANSFER TO: XXXX

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**************(line 23 reserved for applications information)*****************

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**************(Line 24 Reserved for Operating Systems Information)***********



Proposed CADR screen showing changes for UDD – Direct Express.


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1 2 3 4 5 6 7 8

2345678901234567890123456789012345678901234567890123456789012345678901234567890

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C

MCS CLAIMANT MAILING ADDRESS CADR SC90

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0

NH: SSSSSSSSS SSSSS SSSSSSSSSS CL: SSSSSSSSS SSSSS SSSSSSSSSS

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4

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*ADDRESS 1: PPPPPPPPPPPPPPPPPPPPPP ADDRESS 2: PPPPPPPPPPPPPPPPPPPPPP

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ADDRESS 3: PPPPPPPPPPPPPPPPPPPPPP ADDRESS 4: PPPPPPPPPPPPPPPPPPPPPP

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*CITY: PPPPPPPPPPPPPPPPPPPPPP STATE: PP ZIP: PPPPP

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STATE & COUNTY CODE: PPPPPP COUNTY: XXXXXXXXXXXXXXX

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COUNTRY: PPPPPPPPPPPPPPPPPPPPPP CONSULAR CODE: PPP

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FOREIGN POSTAL ZONE: PPPPPPPPPPPPPPP

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BANK ACCOUNT (Y/N): X DIRECT EXPRESS (Y/N): X

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DIRECT DEPOSIT ROUTING TRANSIT NUMBER: 999999999 ACCOUNT TYPE (C/S): A

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DEPOSITOR ACCOUNT NUMBER: 99999999999999999

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d


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DOMESTIC PHONE: PPPPPPPPPP FOREIGN PHONE: PPPPPPPPPPPPPPP

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TRANSFER TO: XXXX

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**************(line 23 reserved for applications information)*****************

24


**************(Line 24 Reserved for Operating Systems Information)***********


File Typeapplication/msword
File TitleCurrent CADR Screen:
Author236746
Last Modified By177717
File Modified2008-05-12
File Created2008-05-12

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