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pdfiAppeals Screen Package
October 06, 2011
General Notes
The design goals of this release were:
Reduce sign-in/re-entry errors
Improve and streamline language throughout iAppeals application
Reduce number of pages presented in the iAppeals application (e.g., information may now be behind
“links” and not displayed on the page
Re-design the iAppeals and Disability Report landing pages in an effort to move to the similar look and
feel of our newer eService applications
Add a link to a checklist of information and documents the user may need before starting the application
Add a link for a new iAppeals introductory video
Add a link to the “Special Instructions for Blind Users” to the landing page
Modify the focus of the “Enter” button
Re-label and move the “Sign Off” button
Consider re-labeling the “Continue” button
Due to the extremely short timeframe for this project, the scope of the language changes was strictly limited to
expository verbiage. Throughout the entire application (covering the 501, 561, and 3441), no changes of any kind
were made to user input fields, to field labels, or to questions being presented to the users (in other words,
nothing within the alternating color bands depicting data requested from users).
Global Changes
While the scope of this release allows for only incremental changes, we are proposing some small changes to
bring iAppeals more closely into alignment with iClaim and the i3368. To that end, the following changes are
proposed:
"Continue" button renamed to "Next"
"Sign Off" button (beginning on page ap011 and continuing through page rs003):
o renamed to "Sign Off (finish later)"
o moved (from top left corner to bottom left corner)
"Send" button (501/561 Request on page ap010 and 3441 Report on page rs003) renamed to "Submit"
"Finished" button renamed to "Finish"
Removed bold from all buttons throughout the application
In footer, replaced “How to Move Around This Report” with “Tips for Using this Website” (new name for
msg022)
Deleted Pages
The language changes proposed for this release render the following pages obsolete:
Screen Number
ap002
ap006hr
ap006rc
ap007
ee004
ay012
mh001
mh021
mh022
Screen Name
About this Internet Appeal Process
About the Request for Hearing by Administrative Law Judge
About the Request for Reconsideration
How this Internet appeal request works
How the online Appeal Disability Report works
About you: end of part 1
Medical history: introduction
Medical history: summary
Medical history: end of part 2
rs006
rs009
Review and send: print your medical release form
Confirmation
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October 06, 2011
Screen Number
msg023
msg041
msg004
Screen Name
How the online Disability Report works
About your notice and claim numbers
Internet security policy
Changes to the language also affect the path of the application. The following pages will change from being
pages within the path to become pop-up pages referenced by their respective links on screen rs004 Confirmation
and printing:
Former Number
rs005
rs008
Former Name
Print the cover sheet
Print the Questionnaire for Children
Claiming SSI Benefits
New Number New Name
msg081
Cover sheet
msg082
(no change)
Dynamic Behavior
The iAppeals application handles appeals both for the Reconsideration and Hearing phases of a claim. When a
claimant with a denial on file complete and submits page ap005 Claimant information, the system determines
which phase the claim is in and displays pages from the appropriate path. This screen package includes both the
Reconsideration and Hearing versions of affected screens, denoted as either “rc” or “hr” added to the screen
number (e.g., ap008rc and ap008hr).
At the end of the 3441, the user is presented with a confirmation page with a link to his receipt and a list of links to
documents that are needed based upon his specific case. (The list is repeated in his customized cover sheet.)
Four links are always displayed; three more may be displayed based on the user’s specific case.
Always display:
Receipt for disability appeal report
Cover sheet
SSA-827 Medical Release Form (Authorization to Disclose Information to the Social Security
Administration)
instructions (for completing the medical release form)
Display, if:
Form Number and Title
SSA-1696 Appointment of
Representative
HA-4608 Waiver of Your Right to
Personal Appearance before ALJ
SSA-3881 Questionnaire for Children
Claiming SSI Benefits
Based on page
ap008rc,
ap008hr
ap008hr
ap005
Condition
Question “Do you currently have a
representative?” answered Yes
Question “Do you wish to appear at
the hearing?” answered No
Claimant age < 18 years(calculated
from date of birth)
However, if a user loses his reentry number before completing the 3441 and begins a new report, the system can
no longer present a customized list. In that situation, the system would present the all possible forms the user
may need. [See rs004 Confirmation and printing (Longest possible version) and msg081 Cover sheet (Longest
possible version).]
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October 06, 2011
Screen Images
Appeal Request (501/561) .......................................................................................................................................................... 4
ap001 Welcome ...................................................................................................................................................................... 4
ap004 Can you use this online disability appeal ...................................................................................................................... 5
ap005 Claimant information..................................................................................................................................................... 6
ap008rc Request for reconsideration ...................................................................................................................................... 7
ap008hr Request for hearing by administrative law judge ....................................................................................................... 9
ap010rc Submit your request for reconsideration (1st party) ................................................................................................. 11
ap010rc Submit your request for reconsideration (3rd party) ................................................................................................ 12
ap010hr Submit your request for hearing (1st party) ............................................................................................................. 13
ap010hr Submit your request for hearing (3rd party)............................................................................................................. 14
ap011rc Receipt for reconsideration (1st party)..................................................................................................................... 15
ap011rc Receipt for reconsideration (3rd party) .................................................................................................................... 16
ap011hr Receipt for hearing (1st party) ................................................................................................................................. 17
ap011hr Receipt for hearing (3rd party)................................................................................................................................. 18
Disability Report (3441): About You ....................................................................................................................................... 19
ay001 About you: general information ................................................................................................................................... 19
ay001 About you: general information - fillable (conditional) ................................................................................................. 20
ay002 Print your reentry number (conditional)....................................................................................................................... 21
Entry and Exit ........................................................................................................................................................................... 22
ee011 Are you sure you want to sign off ............................................................................................................................... 22
ee009 Welcome back ............................................................................................................................................................ 23
Review and Send ...................................................................................................................................................................... 24
rs001 Review and send: summary ........................................................................................................................................ 24
rs002 Review and send: additional remarks about your case ............................................................................................... 25
rs003 Review and send: submit this appeal .......................................................................................................................... 26
rs004 Confirmation and printing (Reconsideration, 1st party)................................................................................................ 27
rs004 Confirmation and printing (Reconsideration, 3rd party) ............................................................................................... 28
rs004 Confirmation and printing (Hearing, 1st party, did not waive right to appear) .............................................................. 29
rs004 Confirmation and printing (Hearing, 3rd party, waived right to appear at hearing) ...................................................... 30
rs004 Confirmation and printing (Longest possible version) .................................................................................................. 31
msg080 Receipt for disability appeal report........................................................................................................................... 32
msg081 Cover sheet (Reconsideration, 1st party) ................................................................................................................ 33
msg081 Cover sheet (Reconsideration, 3rd party) ................................................................................................................ 34
msg081 Cover sheet (Hearing, 1st party, did not waive right to appear) ............................................................................... 35
msg081 Cover sheet (Hearing, 3rd party, waived right to appear at hearing) ....................................................................... 36
msg081 Cover sheet (Longest possible version)................................................................................................................... 37
Messages .................................................................................................................................................................................. 38
msg007 Checklist: information you will need ......................................................................................................................... 38
msg022 Tips for using this website ....................................................................................................................................... 39
msg040 What is my notice date ............................................................................................................................................ 40
msg041 About your notice ..................................................................................................................................................... 41
msg043 About your claim number ......................................................................................................................................... 42
msg046 Other ways to complete a disability appeal .............................................................................................................. 43
msg048 Submitting additional medical evidence ................................................................................................................... 44
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Appeal Request (501/561)
ap001 Welcome
Link Details
Link Text
Notice of Decision
Video: Preparing to File…
Note: title still under review
Checklist: Information You Will…
Tips For Using This Website
Link Destination
msg041 About your notice
URL not yet available
Instructions for Blind or...
http://www.socialsecurity.gov/webcontent/accessibility.htm *May
be changed by ASB
msg001 Social Security’s definitions of disability
msg002 How the disability Appeals Process works
msg003 Social Security’s disability programs
msg005 Your right to representation
msg046 Other ways to complete a disability appeal
msg051 Contact us
Page ap004 Can you use this online disability appeal
Page ee009 Welcome back
Social Security’s Definition…
How the Disability Appeal…
Information About Social...
Your Right to Representation
Other Ways to Complete…
Contact Us
Button: Start Your Appeal
Button: Go Back to the Appeal…
msg007 Checklist: information you will need
msg022 Tips for using this websitemsg022 Tips for using this website
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ap004 Can you use this online disability appeal
Link Details
Link Text
notice of decision
Link Destination
msg041 About your notice
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ap005 Claimant information
Link Details
Link Text
What is My Notice Date?
Link Destination
msg040 What is my notice date
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ap008rc Request for reconsideration
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Link Details
Link Text
Paperwork Reduction Act
Privacy Act Statement
Who is the Wage Earner?
What is the Claim Number?
Link Destination
msg072rc Paperwork Reduction Act (rc)
msg139 Privacy Information
msg042 Who is the wage earner?
msg043 About your claim number
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ap008hr Request for hearing by administrative law judge
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“Do you wish to appear at the hearing?” The user’s response determines whether the Waiver form will be
included on the Confirmation page and Cover sheet.
st
“Do you currently have a representative?” The user’s response determines which path (1 party screens
rd
or 3 party screens) he will receive.
Link Details
Link Text
Paperwork Reduction Act
Privacy Act Statement
What is the Claim Number?
Who is the Wage Earner?
Submitting Additional Evidence
Waiver of Your Right to…
more about representatives
Link Destination
msg072hr Paperwork Reduction Act (hr)
msg139 Privacy Information
msg043 About your claim number
msg042 Who is the wage earner?
msg048 Submitting additional medical evidence
http://www.socialsecurity.gov/online/ha-4608.pdf
msg005 Your right to representation
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ap010rc Submit your request for reconsideration (1st party)
Page 11
October 06, 2011
ap010rc Submit your request for reconsideration (3rd party)
Page 12
October 06, 2011
ap010hr Submit your request for hearing (1st party)
Page 13
October 06, 2011
ap010hr Submit your request for hearing (3rd party)
Page 14
October 06, 2011
ap011rc Receipt for reconsideration (1st party)
Note: This is the first time the user is presented with a reentry number. The Sign Off button is presented
beginning on this page and continuing until the completed submission of the disability report (3441).
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ap011rc Receipt for reconsideration (3rd party)
Note: This is the first time the user is presented with a reentry number. The Sign Off button is presented
beginning on this page and continuing until the completed submission of the disability report (3441).
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ap011hr Receipt for hearing (1st party)
Note: This is the first time the user is presented with a reentry number. The Sign Off button is presented
beginning on this page and continuing until the completed submission of the disability report (3441).
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October 06, 2011
ap011hr Receipt for hearing (3rd party)
Note: This is the first time the user is presented with a reentry number. The Sign Off button is presented
beginning on this page and continuing until the completed submission of the disability report (3441).
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Disability Report (3441): About You
ay001 About you: general information
Users moving through the application in order will have already entered personal information (name,
address, telephone number), and those entries are carried forward here. However, these entries are not
carried forward if a user should (for whatever reason) abandon the report and chose to begin a new
report. Users who do so would instead see a fillable version of this page (see next page--ay001 About
you: general information - fillable (conditional)).
Link Details
Link Text
Paperwork Reduction Act
Privacy Act Statement
Link Destination
msg072 Paperwork Reduction Act
msg139 Privacy Information
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ay001 About you: general information - fillable (conditional)
This fillable version of page ay001 would only be seen by users who (for whatever reason) abandon the
report and chose to begin a new report.
Link Details
Link Text
Paperwork Reduction Act
Privacy Act Statement
Link Destination
msg072 Paperwork Reduction Act
msg139 Privacy Information
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ay002 Print your reentry number (conditional)
Users moving through the application in order will have already received an entry number on ap011rc
Receipt for reconsideration (1st party). For those users, this page would be suppressed from the path.
This page would be shown only to users who complete a Request for appeal, receive a reentry number to
begin the Report portion, and then (for whatever reason) abandon the report and have chosen to begin a
new report.
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Entry and Exit
ee011 Are you sure you want to sign off
This page is invoked whenever the user selects the “Sign Off (finish later)” button.
Link Details
Link Text
other ways to complete your…
Link Destination
msg046 Other ways to complete a disability appeal
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ee009 Welcome back
Link Details
Link Text
other ways to complete your…
Link Destination
msg046 Other ways to complete a disability appeal
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Review and Send
rs001 Review and send: summary
Page 24
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rs002 Review and send: additional remarks about your case
Page 25
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rs003 Review and send: submit this appeal
Page 26
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rs004 Confirmation and printing (Reconsideration, 1st party)
Page 27
October 06, 2011
rs004 Confirmation and printing (Reconsideration, 3rd party)
Page 28
October 06, 2011
rs004 Confirmation and printing (Hearing, 1st party, did not waive right to appear)
Page 29
October 06, 2011
rs004 Confirmation and printing (Hearing, 3rd party, waived right to appear at hearing)
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October 06, 2011
rs004 Confirmation and printing (Longest possible version)
If a user loses his reentry number before completing the 3441 and begins a new report, the system can
no longer present a customized list and would instead present the all possible forms the user may need.
Link Details
Link Text
Receipt for disability appeal report
Cover sheet
Medical Release Form…
instructions
Form SSA-1696…
Form HA-4608…
Form SSA-3881…
downloading and printing PDF…
Link Destination
msg080 Receipt for disability appeal report
msg081 Cover sheet (Longest possible version)
http://www.socialsecurity.gov/online/ssa-827.pdf
msg060 How to complete the medical release form
http://www.socialsecurity.gov/online/ssa-1696.pdf
http://www.socialsecurity.gov/online/ha-4608.pdf
http://www.socialsecurity.gov/online/ssa-3881.pdf
http://www.socialsecurity.gov/webcontent/adobe.htm
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msg080 Receipt for disability appeal report
Page 32
October 06, 2011
msg081 Cover sheet (Reconsideration, 1st party)
Page 33
October 06, 2011
msg081 Cover sheet (Reconsideration, 3rd party)
Page 34
October 06, 2011
msg081 Cover sheet (Hearing, 1st party, did not waive right to appear)
Page 35
October 06, 2011
msg081 Cover sheet (Hearing, 3rd party, waived right to appear at hearing)
Page 36
October 06, 2011
msg081 Cover sheet (Longest possible version)
If a user loses his reentry number before completing the 3441 and begins a new report, the system can
no longer present a customized list and would instead present the all possible forms the user may need.
Page 37
October 06, 2011
Messages
msg007 Checklist: information you will need
Page 38
October 06, 2011
msg022 Tips for using this website
Link Details
Link Text
web accessibility policy and…
Link Destination
http://www.socialsecurity.gov/webcontent/accessibility.htm
Page 39
October 06, 2011
msg040 What is my notice date
Page 40
October 06, 2011
msg041 About your notice
Page 41
October 06, 2011
msg043 About your claim number
Page 42
October 06, 2011
msg046 Other ways to complete a disability appeal
Link Details
This links on this page are identical (in both link text and link destination) to the page currently in
production.
Page 43
October 06, 2011
msg048 Submitting additional medical evidence
Page 44
October 06, 2011
| File Type | application/pdf |
| File Title | iAppeals Screen Package |
| Subject | Screen Package Deliverable |
| Author | Brenda J. Butler |
| File Modified | 2011-10-28 |
| File Created | 2011-10-28 |