Cms-10440

Appendix B
We provide two video demonstrations of the interactive online application. The list of questions
in Appendix A includes every item used to collect information across all scenarios. These
videos, posted on YouTube, show the user interface and interactivity for two scenarios described
below. In each video, images of computer screens from the application are shown one by one.
Narration explains the content of each screen, which covers family and household information,
income, and eligibility for affordability programs. The screens provide text boxes plus a
selection of check boxes and buttons. Based on the information provided, the application steers
an applicant along the correct track, posing only relevant questions. The process concludes with
a printable summary of the applications. Both videos are located on the CMS YouTube Channel
at the following link: http://www.youtube.com/cmshhsgov.

SCENARIO 1. A family of three.
Video Title: Single Streamlined Application - Family Scenario
This scenario uses an example of a fictional Missouri family of three, Jane, John, and Sam Doe.
After answering all appropriate questions, the parents are determined to be eligible for Advance
Payments of the Premium Tax Credit and the son qualified for Medicaid.

SCENARIO 2. An individual from Arizona.
Video Title: Single Streamlined Application - Individual Scenario
This scenario uses an example of a fictional single man from Arizona, William Doe. After
answering all appropriate questions, he is determined to be eligible for Advance Payments of the
Premium Tax Credit.