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pdfIAPPEALS REVITALIZATION 2013
SCREEN PACKAGE
VERSION 2.2
iAppeals Revitalization 2013: Screen Package v. 2.2
Contents
1. Screen Package Version Information .................................................................................................................. 7
2. About this Screen Package .................................................................................................................................. 7
3. Third Party Screen Designs ................................................................................................................................. 8
3.1. Welcome Page ............................................................................................................................................. 8
3.2. Screening...................................................................................................................................................... 9
3.3. Screening: Lives in US ................................................................................................................................ 10
3.4. Who is Entering Appeal.............................................................................................................................. 11
3.5. Who is Entering Appeal: Entering for Sarah Jones .................................................................................... 12
3.6. Who is Entering Appeal: Representative Selected .................................................................................... 13
3.7. Who is Entering Appeal: Other Selected ................................................................................................... 14
3.8. Reentry Number – 3rd Party ....................................................................................................................... 15
3.9. Reentry Number – 3rd Party: Email Selected ............................................................................................. 16
3.10. Are You Sure You Want to Exit – 3rd Party ............................................................................................... 17
3.11. Return to a Saved Appeal – 3rd Party ....................................................................................................... 18
3.12. Who are You – 3rd Party ........................................................................................................................... 19
3.13. Who are You – 3rd Party: Someone Else .................................................................................................. 20
3.14. Who are You – 3rd Party: Other Selected ............................................................................................... 22
3.15. Preparer – 3rd Party................................................................................................................................. 23
3.16. Rep Information – 3rd Party Professional Rep ......................................................................................... 24
3.17. Applicant Info – 3rd Party ......................................................................................................................... 25
3.18. Rep – 3rd Party.......................................................................................................................................... 27
3.19. Rep – 3rd Party: Yes Selected ................................................................................................................... 28
3.20. Request for Reconsideration – 3rd Party................................................................................................. 29
3.21. Request for Hearing – 3rd Party ............................................................................................................... 30
3.22. Someone We Can Contact – 3rd Party .................................................................................................... 31
3.23. Someone We Can Contact – 3rd Party: No one selected ........................................................................ 32
3.24. Someone We Can Contact – 3rd Party: Someone else selected ............................................................. 33
3.25. Someone We Can Contact – 3rd Party: Follow up questions .................................................................. 34
3.26. Someone We Can Contact – 3rd Party: Terry Halpern selected.............................................................. 36
3.27. Someone We Can Contact – 3rd Party: Professional Rep ....................................................................... 37
3.28. Section3: Medical Conditions – 3rd Party................................................................................................ 38
3.29. Section3: Medical Conditions – 3rd Party: Follow up questions ............................................................. 39
3.30. Section3: Medical Conditions – 3rd Party: Remarks Pop Up ................................................................... 40
3.31. Section4: Medical Treatment – 3rd Party ............................................................................................... 41
3.32. Section4: Medical Treatment – 3rd Party: Follow up questions ............................................................ 42
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3.33. Doctors & Hospitals – 3rd Party .............................................................................................................. 43
3.34. Add New Doctors – 3rd Party .................................................................................................................. 44
3.35. Add New Doctors – 3rd Party: Test Popup .............................................................................................. 47
3.36. Add New Doctors – 3rd Party: Test Popup with follow up question ....................................................... 48
3.37. Add New Doctors – 3rd Party: Medicine Popup ...................................................................................... 49
3.38. Doctors & Hospitals 1 Row Filled – 3rd Party .......................................................................................... 50
3.39. Add New Hospitals – 3rd Party ............................................................................................................... 51
3.40. Add New Hospitals – 3rd Party: Yes to Treatment Dates ....................................................................... 54
3.41. Doctors & Hospitals 2 Rows Filled – 3rd Party......................................................................................... 57
3.42. Tests – 3rd Party ...................................................................................................................................... 58
3.43. Add New Test – 3rd Party ....................................................................................................................... 59
3.44. Add New Test – 3rd Party: Follow up question and Other Doctor ......................................................... 61
3.45. Add New Test – 3rd Party: Have not seen the doctor ............................................................................ 62
3.46. Add New Test – 3rd Party: Have seen the doctor................................................................................... 63
3.47. Add New Test – 3rd Party: Other Hospital.............................................................................................. 65
3.48. Tests 3 Rows Filled – 3rd Party ................................................................................................................ 67
3.49. Medicines – 3rd Party .............................................................................................................................. 68
3.50. Add New Medicine – 3rd Party ................................................................................................................ 69
3.51. Add New Medicine – 3rd Party: Other doctor ......................................................................................... 70
3.52. Add New Medicine – 3rd Party: Have not seen the doctor ..................................................................... 71
3.53. Add New Medicine – 3rd Party: Have seen the doctor ........................................................................... 72
3.54. Add New Medicine – 3rd Party: Other Hospital ...................................................................................... 75
3.55. Medicines 3 Rows Filled – 3rd Party ........................................................................................................ 78
3.56. Section5: Other Medical Info – 3rd Party ................................................................................................ 79
3.57. Section5: Other Medical Info – 3rd Party: Yes selected .......................................................................... 80
3.58. Add Other Medical Info – 3rd Party......................................................................................................... 81
3.59. Added Other Medical Info – 3rd Party..................................................................................................... 83
3.60. Section7: Activities – 3rd Party ................................................................................................................ 84
3.61. Section7: Activities – 3rd Party: Follow up question ............................................................................... 85
3.62. Section8: Work & Education – 3rd Party ................................................................................................. 86
3.63. Section8: Work Education – 3rd Party: Follow up question ................................................................... 87
3.64. Section9: Voc Rehab – 3rd Party: First follow up question .................................................................... 88
3.65. Section9: Voc Rehab – 3rd Party: Second follow up questions ............................................................... 89
3.66. Remarks – 3rd Party ................................................................................................................................. 90
3.67. Medical Release – 3rd Party .................................................................................................................... 91
3.68. Medical Release – 3rd Party: Applicant is Present ................................................................................... 92
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3.69. Medical Release – 3rd Party: Applicant is Not Present ............................................................................ 93
3.70. Medical Release – 3rd Party Professional Rep.......................................................................................... 94
3.71. Medical Release – 3rd Party Professional Rep: Has signed form ............................................................. 95
3.72. Medical Release – 3rd Party Professional Rep: Does not have signed form ............................................ 96
3.73. Medical Release – 3rd Party Professional Rep: Applicant is Present ....................................................... 97
3.74. Medical Release – 3rd Party Professional Rep: Applicant is Not Present................................................. 98
3.75. Overall Summary – 3rd Party Public ......................................................................................................... 99
3.76. Attach File: No Files Added .................................................................................................................... 104
3.77. Attach Files: File Details dialog box ....................................................................................................... 105
3.78. Attach Files: Browse for file to attach ................................................................................................... 106
3.79. Attach Files: Select Document Type ...................................................................................................... 107
3.80. Attach Files: One file attached ............................................................................................................... 108
3.81. Attach Files: Delete Confirmation .......................................................................................................... 109
3.82. Attach Files: Maximum (10) number of files attached .......................................................................... 110
3.83. Confirmation with Attachments – 3rd Party Public ................................................................................ 111
3.84. Confirmation without Attachments – 3rd Party Public: With Bullets..................................................... 112
3.85. Receipt Pop up without Attachments – 3rd Party Public ....................................................................... 113
3.86. Cover Sheet Popup – 3rd Party Public .................................................................................................... 118
3.87. Cover Sheet Content – 3rd Party Public.................................................................................................. 119
3.88. Overall Summary – Showing section for 3rd Party Professional Rep ..................................................... 120
3.89. Confirmation – 3rd Party Professional Rep............................................................................................. 121
3.90. Confirmation – 3rd Party Professional Rep: With Bullets ....................................................................... 122
3.91. Receipt Pop up – 3rd Party Professional Rep ......................................................................................... 123
4. First Party Screen Designs ............................................................................................................................... 128
4.1. Reentry Number – 1st Party ..................................................................................................................... 128
4.2. Reentry Number – 1st Party: Email Selected ............................................................................................ 129
4.3. Are You Sure You Want to Exit ................................................................................................................ 130
4.4. Return to a Saved Appeal ........................................................................................................................ 131
4.5. Who are You – 1st Party ........................................................................................................................... 132
4.6. Applicant Detail – 1st Party ...................................................................................................................... 133
4.7. Rep – 1st Party .......................................................................................................................................... 134
4.8. Rep – 1st Party: Yes Selected .................................................................................................................... 135
4.9. Request for Reconsideration – 1st Party .................................................................................................. 136
4.10. Request for Hearing – 1st Party .............................................................................................................. 137
4.11. Someone We Can Contact – 1st Party .................................................................................................... 138
4.12. Someone We Can Contact – 1st Party: Follow up questions ................................................................. 139
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4.13. Someone We Can Contact – 1st Party: No Contact ............................................................................... 140
4.14. Section3: Medical Conditions – 1st Party ............................................................................................... 141
4.15. Section3: Medical Conditions – 1st Party: Follow Up questions ............................................................ 142
4.16. Section4: Medical Treatment – 1st Party .............................................................................................. 143
4.17. Section4: Medical Treatment – 1st Party: Follow Up Questions ........................................................... 144
4.18. Doctors & Hospitals – 1st Party .............................................................................................................. 145
4.19. Add New Doctors – 1st Party .................................................................................................................. 146
4.20. Add New Doctors – 1st Party: Test Popup .............................................................................................. 149
4.21. Add New Doctors – 1st Party: Test Popup with follow up question ...................................................... 150
4.22. Add New Doctors – 1st Party: Medicine Popup ..................................................................................... 151
4.23. Doctors & Hospitals – 1st Party: 1 Row Filled......................................................................................... 152
4.24. Add New Hospitals – 1st Party ............................................................................................................... 153
4.25. Add New Hospitals – 1st Party: Yes to Treatment Dates....................................................................... 156
4.27. Doctors & Hospitals – 1st Party: 2 Rows Filled ....................................................................................... 159
4.28. Tests – 1st Party ..................................................................................................................................... 160
4.29. Add New Test – 1st Party ....................................................................................................................... 161
4.30. Add New Test – 1st Party: Follow up question and Other Doctor ........................................................ 163
4.31. Add New Test – 1st Party: Have not seen the doctor ............................................................................ 164
4.32. Add New Test – 1st Party: Have seen the doctor .................................................................................. 165
4.33. Add New Test – 1st Party: Other Hospital ............................................................................................. 168
4.34. Tests – 1st Party: 3 Rows Filled ............................................................................................................... 171
4.35. Medicines – 1st Party.............................................................................................................................. 172
4.36. Add New Medicine – 1st Party ............................................................................................................... 173
4.37. Add New Medicine – 1st Party: Other Doctor ........................................................................................ 174
4.38. Add New Medicine – 1st Party: Have not seen the doctor .................................................................... 175
4.39. Add New Medicine – 1st Party: Have seen the doctor ........................................................................... 176
4.40. Add New Medicine – 1st Party: Other Hospital ...................................................................................... 179
4.41. Medicines – 1st Party: 3 Rows Filled ...................................................................................................... 182
4.42. Section5: Other Medical Info – 1st Party................................................................................................ 183
4.43. Section5: Other Medical Info – 1st Party: Yes selected .......................................................................... 184
4.44. Add Other Medical Info – 1st Party: Details ........................................................................................... 185
4.45. Added Other Medical Info – 1st Party: One Row Filled .......................................................................... 187
4.46. Section7: Activities – 1st Party................................................................................................................ 188
4.47. Section7: Activities – 1st Party: Follow up question............................................................................... 189
4.48. Section8: Work & Education – 1st Party................................................................................................. 190
4.49. Section8: Work & Education – 1st Party: Follow up question ................................................................ 191
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4.50. Section9: Voc Rehab – 1st Party: First follow up question ..................................................................... 192
4.51. Section9: Voc Rehab – 1st Party: Second follow up questions .............................................................. 193
4.52. Remarks – 1st Party ................................................................................................................................ 194
4.54. Medical Release – 1st Party .................................................................................................................... 195
4.55. Overall Summary – 1st Party .................................................................................................................. 196
4.57. Attach Files: No Files Attached .............................................................................................................. 201
4.58. Confirmation – 1st Party ........................................................................................................................ 202
4.59. Receipt Pop up – 1st Party ...................................................................................................................... 203
4.60. Cover Sheet Popup – 1st Party ............................................................................................................... 208
4.61. Cover Sheet Content – 1st Party ............................................................................................................ 209
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1. Screen Package Version Information
The first release of this Screen Package as a project deliverable is numbered 1.0. The second release is 2.0.
Version
Number
Date
Content Revisions
Page
#
0.1 (Draft)
09/24/2013
1.0
10/28/2013
UXG final recommendations based on research, testing
Multiple
2.0
02/06/2014
Updated language based on Sponsor Language Change Requests (LCRs)
Multiple
2.1
02/07/2014
Removed the Attachment Utility screens, and made appropriate modifications to pages
affected by the removal of attachment utility screens
Multiple
2.2
02/11/2014
Addressed any omissions due to multiple screens or dynamic panel edits
Multiple
Revised
by
2. About this Screen Package
This screen package is intended to provide snapshots of the various possible states of the iAppeals screens.
There are some global changes for the prototype which are not reflected in this document.
1. There has been a change to the instructional text for dates. The UXG recommendation:
“Enter the closest date [you] can remember. Examples: 6/2/2013; June 2013; Summer 2013.”
will be changed in production to:
“If the exact date is unknown, enter an approximate date. Examples: 6/2/2013; June 2013; Summer
2013.”
2. There has been a change to the field label and instructional text for side effects (for medicines). The
UXG recommendation:
Describe any side effects Sarah Jones experienced while taking this medicine:
will be changed in production to:
Describe any side effects Sarah Jones has while taking this medicine:
If none, enter "None"
There are some additional minor inconsistencies (typographical errors) in the prototype that are incidental
and immaterial to the OMB approval process. The work effort of correcting the inconsistencies within the
prototype is prohibitively great, but these errors will be corrected in the production version of the application.
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3. Third Party Screen Designs
3.1. Welcome Page
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3.2. Screening
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3.3. Screening: Lives in US
If state or territory is selected here, it is propagated to Applicant Detail page.
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3.4. Who is Entering Appeal
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3.5. Who is Entering Appeal: Entering for Sarah Jones
Contents of relationship drop list:
-Appointed Representative (Attorney) or Staff
Appointed Representative (Non-Attorney) or Staff
Family Member
Friend/Neighbor
Government Agency
Health Service Agency/Hospital
Non-Profit Organization/Legal Aid Group
Nursing Care Facility
Social Worker
Other
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3.6. Who is Entering Appeal: Representative Selected
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3.7. Who is Entering Appeal: Other Selected
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3.8. Reentry Number – 3rd Party
Option to enter email address is not provided if the user navigates back to this page and already provided an
email address.
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3.9. Reentry Number – 3rd Party: Email Selected
Option to enter email address is not provided if the user navigates back to this page and already provided an
email address.
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3.10. Are You Sure You Want to Exit – 3rd Party
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3.11. Return to a Saved Appeal – 3rd Party
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3.12. Who are You – 3rd Party
The possibilities for the radio list are determined based on data already provided in the claim. The names
shown would correspond to the roles, which should be shown in the following order:
1.
2.
3.
4.
5.
claimant (always appears)
third party preparer, if any
person listed on "Someone we can contact" page, if any
representative, if any, if different from preparer
someone else, helping to appeal (always appears)
If option 5 is selected and completed, the data entered replaces any preparer information previously provided.
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3.13. Who are You – 3rd Party: Someone Else
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Contents of relationship drop list:
-Appointed Representative (Attorney) or Staff
Appointed Representative (Non-Attorney) or Staff
Family Member
Friend/Neighbor
Government Agency
Health Service Agency/Hospital
Non-Profit Organization/Legal Aid Group
Nursing Care Facility
Social Worker
Other
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3.14. Who are You – 3rd Party: Other Selected
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3.15. Preparer – 3rd Party
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3.16. Rep Information – 3rd Party Professional Rep
Note: the right-hand secondary navigation adjusts based on selections made in the screening stages. In this
example, the representative is completing the appeal.
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3.17. Applicant Info – 3rd Party
State is prefilled based on selection on screening page, if applicable. Gender is only asked of third parties.
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3.18. Rep – 3rd Party
This version of the Representative page would be shown only if a representative has not already been
identified.
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3.19. Rep – 3rd Party: Yes Selected
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3.20. Request for Reconsideration – 3rd Party
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3.21. Request for Hearing – 3rd Party
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3.22. Someone We Can Contact – 3rd Party
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3.23. Someone We Can Contact – 3rd Party: No one selected
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3.24. Someone We Can Contact – 3rd Party: Someone else selected
Contents of relationship drop list:
-Family Member
Friend/Neighbor
Government Agency
Health Service Agency/Hospital
Non-Profit Organization/Legal Aid Group
Nursing Care Facility
Social Worker
Other
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3.25. Someone We Can Contact – 3rd Party: Follow up questions
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3.26. Someone We Can Contact – 3rd Party: Terry Halpern selected
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3.27. Someone We Can Contact – 3rd Party: Professional Rep
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3.28. Section3: Medical Conditions – 3rd Party
1
1
Note: the language for these questions has been changed per stakeholders. It does not reflect the recommendation of the User
Experience Group.
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3.29. Section3: Medical Conditions – 3rd Party: Follow up questions
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3.30. Section3: Medical Conditions – 3rd Party: Remarks Pop Up
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3.31. Section4: Medical Treatment – 3rd Party
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3.32. Section4: Medical Treatment – 3rd Party: Follow up questions
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3.33. Doctors & Hospitals – 3rd Party
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3.34. Add New Doctors – 3rd Party
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3.35. Add New Doctors – 3rd Party: Test Popup
Contents of "Test Type" drop list:
-Biopsy
Blood Test (not HIV)
Breathing Test
Cardiac Catheterization
EEG (Brain Wave Test)
EKG (Heart Test)
Hearing Test
HIV Test
IQ Test
MRI / CT Scan
Speech / Language Test
Treadmill (Exercise Test)
Vision Test
X-Ray
Other
Of these Test Types, selection of the following items will dynamically display a Body Part:
Biopsy
X-Ray
Other
Selecting “Other” will also dynamically display a “Please specify test type” text field.
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3.36. Add New Doctors – 3rd Party: Test Popup with follow up question
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3.37. Add New Doctors – 3rd Party: Medicine Popup
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3.38. Doctors & Hospitals 1 Row Filled – 3rd Party
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3.39. Add New Hospitals – 3rd Party
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3.40. Add New Hospitals – 3rd Party: Yes to Treatment Dates
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3.41. Doctors & Hospitals 2 Rows Filled – 3rd Party
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3.42. Tests – 3rd Party
Table will be prefilled with what was entered in doctors/hospitals pages
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3.43. Add New Test – 3rd Party
Contents of Test Type drop list:
-Biopsy
Blood Test (not HIV)
Breathing Test
Cardiac Catheterization
EEG (Brain Wave Test)
EKG (Heart Test)
Hearing Test
HIV Test
IQ Test
MRI / CT Scan
Speech / Language Test
Treadmill (Exercise Test)
Vision Test
X-Ray
Other
Of these Test Types, selection of the following items will dynamically display a Body Part field:
Biopsy
X-Ray
Other
Selecting “Other” will also dynamically display the “Please specify test type” question.
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Contents of "Who recommended..." drop list:
-(All doctors previously entered)
(All hospitals previously entered)
Other Doctor or Healthcare Provider
Other Hospital or Clinic
No one recommended or prescribed this medicine
I don’t know
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3.44. Add New Test – 3rd Party: Follow up question and Other Doctor
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3.45. Add New Test – 3rd Party: Have not seen the doctor
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3.46. Add New Test – 3rd Party: Have seen the doctor
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3.47. Add New Test – 3rd Party: Other Hospital
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3.48. Tests 3 Rows Filled – 3rd Party
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3.49. Medicines – 3rd Party
Table will be prefilled with information that was entered in doctors/hospitals pages. No medicines have been
provided yet in this example.
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3.50. Add New Medicine – 3rd Party
Contents of "Who recommended..." drop list:
-(All doctors previously entered)
(All hospitals previously entered)
Other Doctor or Healthcare Provider
Other Hospital or Clinic
No one recommended or prescribed this medicine
I don’t know
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3.51. Add New Medicine – 3rd Party: Other doctor
70
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.52. Add New Medicine – 3rd Party: Have not seen the doctor
DCS/OSES/DUAPS/USSB/UXG
71
iAppeals Revitalization 2013: Screen Package v. 2.2
3.53. Add New Medicine – 3rd Party: Have seen the doctor
72
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
DCS/OSES/DUAPS/USSB/UXG
73
iAppeals Revitalization 2013: Screen Package v. 2.2
74
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.54. Add New Medicine – 3rd Party: Other Hospital
DCS/OSES/DUAPS/USSB/UXG
75
iAppeals Revitalization 2013: Screen Package v. 2.2
76
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
DCS/OSES/DUAPS/USSB/UXG
77
iAppeals Revitalization 2013: Screen Package v. 2.2
3.55. Medicines 3 Rows Filled – 3rd Party
78
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.56. Section5: Other Medical Info – 3rd Party
DCS/OSES/DUAPS/USSB/UXG
79
iAppeals Revitalization 2013: Screen Package v. 2.2
3.57. Section5: Other Medical Info – 3rd Party: Yes selected
80
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.58. Add Other Medical Info – 3rd Party
DCS/OSES/DUAPS/USSB/UXG
81
iAppeals Revitalization 2013: Screen Package v. 2.2
82
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.59. Added Other Medical Info – 3rd Party
DCS/OSES/DUAPS/USSB/UXG
83
iAppeals Revitalization 2013: Screen Package v. 2.2
3.60. Section7: Activities – 3rd Party
84
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.61. Section7: Activities – 3rd Party: Follow up question
DCS/OSES/DUAPS/USSB/UXG
85
iAppeals Revitalization 2013: Screen Package v. 2.2
3.62. Section8: Work & Education – 3rd Party
86
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.63. Section8: Work Education – 3rd Party: Follow up question
DCS/OSES/DUAPS/USSB/UXG
87
iAppeals Revitalization 2013: Screen Package v. 2.2
3.64. Section9: Voc Rehab – 3rd Party: First follow up question
Vocational Rehabilitation
88
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.65. Section9: Voc Rehab – 3rd Party: Second follow up questions
Vocational Rehabilitation
DCS/OSES/DUAPS/USSB/UXG
89
iAppeals Revitalization 2013: Screen Package v. 2.2
3.66. Remarks – 3rd Party
90
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.67. Medical Release – 3rd Party
DCS/OSES/DUAPS/USSB/UXG
91
iAppeals Revitalization 2013: Screen Package v. 2.2
3.68. Medical Release – 3rd Party: Applicant is Present
92
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.69. Medical Release – 3rd Party: Applicant is Not Present
DCS/OSES/DUAPS/USSB/UXG
93
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3.70. Medical Release – 3rd Party Professional Rep
94
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
3.71. Medical Release – 3rd Party Professional Rep: Has signed form
DCS/OSES/DUAPS/USSB/UXG
95
iAppeals Revitalization 2013: Screen Package v. 2.2
3.72. Medical Release – 3rd Party Professional Rep: Does not have signed form
96
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iAppeals Revitalization 2013: Screen Package v. 2.2
3.73. Medical Release – 3rd Party Professional Rep: Applicant is Present
DCS/OSES/DUAPS/USSB/UXG
97
iAppeals Revitalization 2013: Screen Package v. 2.2
3.74. Medical Release – 3rd Party Professional Rep: Applicant is Not Present
98
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3.75. Overall Summary – 3rd Party Public
Please note: If a Yes/No question is answered No, any conditional fields below are not displayed.
DCS/OSES/DUAPS/USSB/UXG
99
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100
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iAppeals Revitalization 2013: Screen Package v. 2.2
DCS/OSES/DUAPS/USSB/UXG
101
iAppeals Revitalization 2013: Screen Package v. 2.2
102
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iAppeals Revitalization 2013: Screen Package v. 2.2
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103
iAppeals Revitalization 2013: Screen Package v. 2.2
3.76. Attach File: No Files Added
To add a file, user selects “Add File” button.
104
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iAppeals Revitalization 2013: Screen Package v. 2.2
3.77. Attach Files: File Details dialog box
User selects “Browse” button to locate file to attach.
DCS/OSES/DUAPS/USSB/UXG
105
iAppeals Revitalization 2013: Screen Package v. 2.2
3.78. Attach Files: Browse for file to attach
User locates file, selects file, selects “Open”.
106
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3.79. Attach Files: Select Document Type
User would select the type of document being attached.
List of options for Attorney Representatives & Staff and Non-Attorney Representatives & Staff:
Appointment of Representative (SSA-1696)
Identifying Information for Possible Direct Payment of Authorized
Fees (SSA-1695)
Fee Agreement
Authorization to Disclose Information to the Social Security
Administration (SSA-827)
Questionnaire for Children Claiming SSI Benefits (SSA-3881)
Good Cause for Late Filing Statement
Representative Brief
Waiver of Your Right to Personal Appearance Before an
Administrative Law Judge (HA-4608)
Consent for Release of Information (SSA-3288)
Medical Evidence
Other Evidence or Form
Note that the following options are not displayed for others:
DCS/OSES/DUAPS/USSB/UXG
Identifying Information for Possible Direct Payment of Authorized
Fees (SSA-1695)
Fee Agreement
Representative Brief
107
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3.80. Attach Files: One file attached
108
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iAppeals Revitalization 2013: Screen Package v. 2.2
3.81. Attach Files: Delete Confirmation
If user selects “Delete” button for any file, dialog box is shown to confirm.
DCS/OSES/DUAPS/USSB/UXG
109
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3.82. Attach Files: Maximum (10) number of files attached
Since the user has added the maximum number of files allowed, the Add File button is no longer shown.
110
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3.83. Confirmation with Attachments – 3rd Party Public
186.4 Kb
201.7 Kb
388.1 Kb
This sample shows an appeal with 2 files attached and uploaded.
DCS/OSES/DUAPS/USSB/UXG
111
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3.84. Confirmation without Attachments – 3rd Party Public: With Bullets
112
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3.85. Receipt Pop up without Attachments – 3rd Party Public
Paragraph beginning "We may review..." is only displayed for a request for hearing, not a reconsideration.
DCS/OSES/DUAPS/USSB/UXG
113
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114
DCS/OSES/DUAPS/USSB/UXG
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DCS/OSES/DUAPS/USSB/UXG
115
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116
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iAppeals Revitalization 2013: Screen Package v. 2.2
DCS/OSES/DUAPS/USSB/UXG
117
iAppeals Revitalization 2013: Screen Package v. 2.2
3.86. Cover Sheet Popup – 3rd Party Public
118
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3.87. Cover Sheet Content – 3rd Party Public
DCS/OSES/DUAPS/USSB/UXG
119
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3.88. Overall Summary – Showing section for 3rd Party Professional Rep
120
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iAppeals Revitalization 2013: Screen Package v. 2.2
3.89. Confirmation – 3rd Party Professional Rep
DCS/OSES/DUAPS/USSB/UXG
121
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3.90. Confirmation – 3rd Party Professional Rep: With Bullets
122
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iAppeals Revitalization 2013: Screen Package v. 2.2
3.91. Receipt Pop up – 3rd Party Professional Rep
Paragraph beginning "an Administrative Law Judge" is only displayed for a request for hearing, not a
reconsideration.
DCS/OSES/DUAPS/USSB/UXG
123
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124
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iAppeals Revitalization 2013: Screen Package v. 2.2
DCS/OSES/DUAPS/USSB/UXG
125
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126
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DCS/OSES/DUAPS/USSB/UXG
127
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4. First Party Screen Designs
4.1. Reentry Number – 1st Party
Option to enter email address is not provided if the user navigates back to this page and already provided an
email address.
128
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4.2. Reentry Number – 1st Party: Email Selected
Option to enter email address is not provided if the user navigates back to this page and already provided an
email address.
OSES/DUAPS/USSB/UXG
129
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4.3. Are You Sure You Want to Exit
If the user did not choose to email the reentry number from the Reentry Number page, the container with the
question "Would you like us to email you this reentry number?" - as shown on the Reentry Number page will be displayed here above the navigation bar. If the user emailed the number previously, the page will
display as shown here.
130
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4.4. Return to a Saved Appeal
OSES/DUAPS/USSB/UXG
131
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4.5. Who are You – 1st Party
The possibilities for the radio list are determined based on data already provided in the claim. The names
shown would correspond to the roles, which should be shown in the following order:
1.
2.
3.
4.
claimant (always appears)
person listed on "Someone we can contact" page, if any
representative, if any
someone else, helping to appeal (always appears)
If option 4 is selected and completed, the data entered replaces the preparer information previously provided.
Further, if any option other than claimant is selected, user will be placed into third party path (see screen 3.13.
Who are You – 3rd Party: Someone Else).
132
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4.6. Applicant Detail – 1st Party
OSES/DUAPS/USSB/UXG
133
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4.7. Rep – 1st Party
134
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4.8. Rep – 1st Party: Yes Selected
OSES/DUAPS/USSB/UXG
135
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4.9. Request for Reconsideration – 1st Party
136
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4.10. Request for Hearing – 1st Party
OSES/DUAPS/USSB/UXG
137
iAppeals Revitalization 2013: Screen Package v. 2.2
4.11. Someone We Can Contact – 1st Party
Contents of relationship drop list:
-Family Member
Friend/Neighbor
Government Agency
Health Service Agency/Hospital
Non-Profit Organization/Legal Aid Group
Nursing Care Facility
Social Worker
Other
138
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4.12. Someone We Can Contact – 1st Party: Follow up questions
OSES/DUAPS/USSB/UXG
139
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4.13. Someone We Can Contact – 1st Party: No Contact
140
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.14. Section3: Medical Conditions – 1st Party
OSES/DUAPS/USSB/UXG
141
iAppeals Revitalization 2013: Screen Package v. 2.2
4.15. Section3: Medical Conditions – 1st Party: Follow Up questions
142
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4.16. Section4: Medical Treatment – 1st Party
OSES/DUAPS/USSB/UXG
143
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4.17. Section4: Medical Treatment – 1st Party: Follow Up Questions
144
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4.18. Doctors & Hospitals – 1st Party
OSES/DUAPS/USSB/UXG
145
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4.19. Add New Doctors – 1st Party
146
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iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
147
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148
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4.20. Add New Doctors – 1st Party: Test Popup
Contents of "Test Type" drop list:
-Biopsy
Blood Test (not HIV)
Breathing Test
Cardiac Catheterization
EEG (Brain Wave Test)
EKG (Heart Test)
Hearing Test
HIV Test
IQ Test
MRI / CT Scan
Speech / Language Test
Treadmill (Exercise Test)
Vision Test
X-Ray
Other
Of these Test Types, selection of the following items will dynamically display a Body Part field:
Biopsy
X-Ray
Other
Selecting “Other” will also dynamically display the “Please specify type” question.
OSES/DUAPS/USSB/UXG
149
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4.21. Add New Doctors – 1st Party: Test Popup with follow up question
150
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iAppeals Revitalization 2013: Screen Package v. 2.2
4.22. Add New Doctors – 1st Party: Medicine Popup
OSES/DUAPS/USSB/UXG
151
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4.23. Doctors & Hospitals – 1st Party: 1 Row Filled
152
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4.24. Add New Hospitals – 1st Party
OSES/DUAPS/USSB/UXG
153
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154
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
155
iAppeals Revitalization 2013: Screen Package v. 2.2
4.25. Add New Hospitals – 1st Party: Yes to Treatment Dates
156
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
157
iAppeals Revitalization 2013: Screen Package v. 2.2
158
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iAppeals Revitalization 2013: Screen Package v. 2.2
4.27. Doctors & Hospitals – 1st Party: 2 Rows Filled
OSES/DUAPS/USSB/UXG
159
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4.28. Tests – 1st Party
Table will be prefilled with what was entered in doctors/hospitals pages
160
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iAppeals Revitalization 2013: Screen Package v. 2.2
4.29. Add New Test – 1st Party
Contents of "Test Type" drop list:
-Biopsy
Blood Test (not HIV)
Breathing Test
Cardiac Catheterization
EEG (Brain Wave Test)
EKG (Heart Test)
Hearing Test
HIV Test
IQ Test
MRI / CT Scan
Speech / Language Test
Treadmill (Exercise Test)
Vision Test
X-Ray
Other
Of these Test Types, selection of the following items will dynamically display a Body Part field:
Biopsy
X-Ray
Other
OSES/DUAPS/USSB/UXG
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iAppeals Revitalization 2013: Screen Package v. 2.2
Selecting “Other” will also dynamically display the “Please specify type” question.
Contents of "Who ordered..." drop list:
-(All doctors previously entered)
(All hospitals previously entered)
Other Doctor or Healthcare Provider
Other Hospital or Clinic
No one recommended or prescribed this medicine
I don't know
162
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4.30. Add New Test – 1st Party: Follow up question and Other Doctor
OSES/DUAPS/USSB/UXG
163
iAppeals Revitalization 2013: Screen Package v. 2.2
4.31. Add New Test – 1st Party: Have not seen the doctor
164
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.32. Add New Test – 1st Party: Have seen the doctor
OSES/DUAPS/USSB/UXG
165
iAppeals Revitalization 2013: Screen Package v. 2.2
166
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
167
iAppeals Revitalization 2013: Screen Package v. 2.2
4.33. Add New Test – 1st Party: Other Hospital
168
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
169
iAppeals Revitalization 2013: Screen Package v. 2.2
170
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4.34. Tests – 1st Party: 3 Rows Filled
OSES/DUAPS/USSB/UXG
171
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4.35. Medicines – 1st Party
Table will be prefilled with medicines previously entered in doctors/hospitals pages. No medicines has been
provided yet in this example.
172
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4.36. Add New Medicine – 1st Party
Contents of "Who ordered..." drop list:
-(All doctors previously entered)
(All hospitals previously entered)
Other Doctor or Healthcare Provider
Other Hospital or Clinic
No one recommended or prescribed this medicine
I don't know
OSES/DUAPS/USSB/UXG
173
iAppeals Revitalization 2013: Screen Package v. 2.2
4.37. Add New Medicine – 1st Party: Other Doctor
174
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.38. Add New Medicine – 1st Party: Have not seen the doctor
OSES/DUAPS/USSB/UXG
175
iAppeals Revitalization 2013: Screen Package v. 2.2
4.39. Add New Medicine – 1st Party: Have seen the doctor
176
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
177
iAppeals Revitalization 2013: Screen Package v. 2.2
178
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.40. Add New Medicine – 1st Party: Other Hospital
OSES/DUAPS/USSB/UXG
179
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180
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
181
iAppeals Revitalization 2013: Screen Package v. 2.2
4.41. Medicines – 1st Party: 3 Rows Filled
182
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iAppeals Revitalization 2013: Screen Package v. 2.2
4.42. Section5: Other Medical Info – 1st Party
OSES/DUAPS/USSB/UXG
183
iAppeals Revitalization 2013: Screen Package v. 2.2
4.43. Section5: Other Medical Info – 1st Party: Yes selected
184
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4.44. Add Other Medical Info – 1st Party: Details
OSES/DUAPS/USSB/UXG
185
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186
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.45. Added Other Medical Info – 1st Party: One Row Filled
OSES/DUAPS/USSB/UXG
187
iAppeals Revitalization 2013: Screen Package v. 2.2
4.46. Section7: Activities – 1st Party
188
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.47. Section7: Activities – 1st Party: Follow up question
OSES/DUAPS/USSB/UXG
189
iAppeals Revitalization 2013: Screen Package v. 2.2
4.48. Section8: Work & Education – 1st Party
190
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.49. Section8: Work & Education – 1st Party: Follow up question
OSES/DUAPS/USSB/UXG
191
iAppeals Revitalization 2013: Screen Package v. 2.2
4.50. Section9: Voc Rehab – 1st Party: First follow up question
Vocational Rehabilitation
192
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.51. Section9: Voc Rehab – 1st Party: Second follow up questions
Vocational Rehabilitation
OSES/DUAPS/USSB/UXG
193
iAppeals Revitalization 2013: Screen Package v. 2.2
4.52. Remarks – 1st Party
194
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.54. Medical Release – 1st Party
OSES/DUAPS/USSB/UXG
195
iAppeals Revitalization 2013: Screen Package v. 2.2
4.55. Overall Summary – 1st Party
Please note: If a Yes/No question is answered No, any conditional fields below are not displayed.
196
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iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
197
iAppeals Revitalization 2013: Screen Package v. 2.2
198
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
199
iAppeals Revitalization 2013: Screen Package v. 2.2
200
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.57. Attach Files: No Files Attached
OSES/DUAPS/USSB/UXG
201
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4.58. Confirmation – 1st Party
This is a sample of a confirmation for a request for Reconsideration.
202
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4.59. Receipt Pop up – 1st Party
In the green Confirmation notice, the paragraph beginning "an Administrative Law Judge” is only displayed for
a request for hearing, not reconsideration.
OSES/DUAPS/USSB/UXG
203
iAppeals Revitalization 2013: Screen Package v. 2.2
204
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
205
iAppeals Revitalization 2013: Screen Package v. 2.2
206
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
OSES/DUAPS/USSB/UXG
207
iAppeals Revitalization 2013: Screen Package v. 2.2
4.60. Cover Sheet Popup – 1st Party
208
DCS/OSES/DUAPS/USSB/UXG
iAppeals Revitalization 2013: Screen Package v. 2.2
4.61. Cover Sheet Content – 1st Party
OSES/DUAPS/USSB/UXG
209
| File Type | application/pdf |
| Author | Rhody, Alan |
| File Modified | 2016-08-10 |
| File Created | 2014-06-13 |