3rd Party iClaim

Ready Retirement (“iRRet”)

Screens for

OMB Clearance Package

Table of Contents

1.0 application entry pages 1

1.1 retirement benefits 1

1.2 disability benefits 2

1.3 Users coming from the Retirment Estimator version 3

1.4 the paperwork reduction act statement 4

1.5 The privacy act statement 5

1.6 restart page 6

2.0 identification: Preparer’s Page for 3^rd Party 7

3.0 identification: verification section 8

3.1 retirement version 8

3.2 disability version 9

4.0 identification: confirmation number 12

5.0 identificaton: personal info section 13

5.1 retirement version 14

6.0 general: family section 15

7.0 general: military section 18

8.0 general: earnings section 19

8.1 Retirement version 22

8.2 disability version 23

8.3 No work or self employment alleged version 24

9.0 general: when to start benefits 26

9.1 First Party applicant is more than six months older than full retirement age 26

9.2 First Party applicant is between full retirement age and six months older than full retirement age 27

9.3 First Party applicant is between four months before full retirement age and full retirement age 28

9.4 First Party applicant is between 61 Years 9 months and four months before full retirement age 29

9.5 First Party applicant is exactly 61 years 8 months of age 30

9.6 3^rd Party version 31

10.0 other benefits: benefit info 33

11.0 other benefits: disability questions 35

12.0 review: overall Summary 39

13.0 review: remarks 40

14.0 submit: send this application 41

14.1 first party version 41

14.2 3^rd party version 42

15.0 next steps: receipt section 43

16.0 next steps: What’s next section 44

16.1 NO disability alleged First Party 44

16.2 NO disability alleged 3^rd Party 47

16.3 disability alleged first party 50

16.4 disability alleged 3^rd party 53

17.0 message pages 56

1.0application entry pages

1.1retirement benefits

1.2disability benefits

1.3Users coming from the Retirment Estimator version

1.4the paperwork reduction act statement

1.5The privacy act statement

1.6restart page (will be shown to users accessing the retirement estimator from the when to start benefits page and then returing to the application and to users who select “continue application” on the welcome page)

2.0identification: Preparer’s Page for 3^rd Party

3.0identification: verification section

3.1retirement version

3.2disability version

4.0 identification: confirmation number

5.0identificaton: personal info section

5.1retirement version

6.0general: family section

7.0general: military section

8.0general: earnings section

8.1Retirement version

8.2disability version

8.3No work or self employment alleged version

9.0general: when to start benefits

9.1First Party applicant is more than six months older than full retirement age

9.2First Party applicant is between full retirement age and six months older than full retirement age

9.3First Party applicant is between four months before full retirement age and full retirement age

9.4First Party applicant is between 61 Years 9 months and four months before full retirement age

9.5First Party applicant is exactly 61 years 8 months of age

9.63^rd Party version

10.0other benefits: benefit info

11.0other benefits: disability questions

12.0review: overall Summary

13.0review: remarks

14.0submit: send this application

14.1first party version

14.23^rd party version

15.0next steps: receipt section

16.0next steps: What’s next section

16.1NO disability alleged First Party

16.2NO disability alleged 3^rd Party

16.3disability alleged first party

16.4disability alleged 3^rd party

17.0 message pages

msg010

msg025

msg029

msg045

msg111

17.1msg112

msg113

msg152

msg153

msg156