1st Party Internet Social Security Benefits Application (iClaim) - Foreign Applicants

iClaim Application Modified Screens
Modified Screen #1
Birth and Citizenship information

We are adding “Provide place of birth as it was known at the time of your birth” (#1) for
clarification purposes.

OMB 0960-0618
0618

Page 1

OISP/OAESP

Modified Screen #2
Legal Resident Information

Wee are adding “Are you a legal resident of the United States?” (#2) to the existing screen. If
the applicant answers “Yes,”” then a free format box appears instructing the applicant to provide
their “Permanent Resident Card” number as an optional field
field.

OMB 0960-0618
0618

Page 2

OISP/OAESP

Modified Screen #3
Military and Diplomatic Postal Addresses

1. We added APO, FPO, and DPO selections in the State/Territory dropdown list (#1).
2. We removed the Email Address fields for Third Party applicants (currently below “What is
the best time to call?” question).

OMB 0960-0618

Page 3

OISP/OAESP

Modified Screen #4
Prior Marriages Screen

We are adding the wording in parenthesis “regardless of how long it lasted” to capture the last
marriage information regardless of the duration of the marriage. We have modified the first
sentence slightly for clarification purposes.

OMB 0960-0618

Page 4

OISP/OAESP

Modified Screen#5
Supplemental information Screen

EW

OMB 0960-0618

Page 5

OISP/OAESP

We added this question to the current iClaim screen to determine U.S residency. If the applicant
answers “Yes,” the system generates a dropdown field to allow the applicant to input the dates
of U.S. residency. The applicant can provide up to four occurrences. If the applicant answers
“No,” the system does not generate anything, but allows the applicant to go to the next question.

OMB 0960-0618

Page 6

OISP/OAESP

Modified Screen#6
Total Earnings Screen

EW

OMB 0960-0618

Page 7

OISP/OAESP

EW

The iClaim application currently collects domestic wage information. However, we added new
questions to capture foreign work since foreign work is determined by the hours worked instead
of money amount. The questions apply to past, present and future years.

OMB 0960-0618

Page 8

OISP/OAESP

Modified Screen #7
Other Pensions/Annuities Screen

We are adding “U.S.” to the current question for clarification purposes.

OMB 0960-0618
0618

Page 9

OISP/OAESP

Modified Screen #8
Reduced Benefits Screen

We are adding “permanent” to the current statement for clarification purposes.

OMB 0960-0618

Page 10

OISP/OAESP

Modified Screen #9
Direct Deposit Details Section
Domestic Screen

1. Adding the new conditional question (#1) for clarity when domestic users own or co-own a
bank account for Direct Deposit.
2. Adding the “warning” language (#2) for clarification.

OMB 0960-0618

Page 11

OISP/OAESP

Modified Screen #9
Direct Deposit Details Section
Domestic Screen

If the domestic applicant answers “No,” the system generates the “Alert” message (yellow box)
to inform the applicant about the new electronic payment mandate.

OMB 0960-0618

Page 12

OISP/OAESP

ew Screen #1
International Direct Deposit (IDD) Screen

This new conditional question appears for applicants with foreign addresses also. If the
applicant answers “No” then no subsequent questions appear, allowing the applicant to continue
to the next screen.

OMB 0960-0618

Page 13

OISP/OAESP

ew Screen #1
International Direct Deposit (IDD) Screen

We incorporated new functionality to identify applicants who indicate having a bank account
for direct deposit who provided us with an address outside the United States. We then present a
new section (#1) to collect International Direct Deposit (IDD).

OMB 0960-0618

Page 14

OISP/OAESP

ew Screen #1
International Direct Deposit (IDD) Screen

If the applicant answers “Yes,” the system generates a conditional drop down for the applicant
to select the “Bank Country.” Depending on the country selected, the system then generates two
to four entry fields to collect the account information. Many of the countries have different
entry requirements; therefore the entry fields are conditional.
We also included a screen “pop up” to assist the applicant to understand what is considered
IDD. The “pop up” appears when the applicant hovers the mouse over the “IDD” segment.

OMB 0960-0618

Page 15

OISP/OAESP

ew Screen #1
International Direct Deposit (IDD) Screen

Depending on the country selected, the system generates two to four entry fields to collect the
account information. Many of the countries have different entry requirements; therefore the
entry fields are conditional.

OMB 0960-0618

Page 16

OISP/OAESP

ew Screen #1
International Direct Deposit (IDD) Screen

If the foreign applicant’s response is “No, use a U.S. Bank,” the system generates the current
bank fields for a “domestic” bank account.

OMB 0960-0618

Page 17

OISP/OAESP

ew Screen #2
Canadian Direct Deposit Screen

We incorporated new functionality to identify applicants who indicate having a bank account
for direct deposit and provided us with a Canadian address (#1). We then present a new section
to collect bank account and currency information (#2).

OMB 0960-0618

Page 18

OISP/OAESP

ew Screen #2
Canadian Direct Deposit Screen

If the Canadian applicant’s response is “No, use a U.S. Bank,” the system generates the current
bank fields for a “domestic” bank account.

OMB 0960-0618

Page 19

OISP/OAESP

Modified Screen #10
Health Insurance Screen

We added “current” to the existing question for clarification purposes.

OMB 0960-0618

Page 20

OISP/OAESP

Modified Screen #10
Health Insurance Screen

If the applicant answers “No” to the first modified question (#1) the subsequent question
appears. We added “current” to the existing second question (#2) for clarification
fication purposes.

OMB 0960-0618
0618

Page 21

OISP/OAESP

Modified Screen#11
Overall Summary Screen

At the end of the application, the system currently presents language explaining the electronic
signature and submission agreement. However, we are adding language specifically related to
U.S residency and foreign work. The language will appear when the system identifies the
applicant as living outside the U.S or as a legal resident.
If applicant answers “Yes” to the legal resident question, they will see the language in bracket
#1 on this page. All other applicants except Medicare - Only, will see the language in bracket
#2.
OMB 0960-0618

Page 22

OISP/OAESP