Current iClaim Screens

iClaim - Current Screens.pdf

Social Security Benefits Application

Current iClaim Screens

OMB: 0960-0618

Document [pdf]
Download: pdf | pdf
READY RETIREMENT (“ICLAIM”)
SCREENS FOR
OMB CLEARANCE PACKAGE

Title: iClaim Screens for OMB Clearance Package

TABLE OF CONTENTS
1.0

APPLICATION ENTRY PAGES .......................................................................................... 1

1.1
1.2
1.3
1.4

RETIREMENT/MEDICARE BENEFITS ............................................................................................................................. 1
DISABILITY BENEFITS .................................................................................................................................................. 2
USERS COMING FROM THE RETIREMENT ESTIMATOR VERSION ..................................................................................... 3
RESTART PAGE (WILL BE SHOWN TO USERS ACCESSING THE RETIREMENT ESTIMATOR FROM THE WHEN TO START
BENEFITS PAGE AND THEN RETURNING TO THE APPLICATION AND TO USERS WHO SELECT “CONTINUE APPLICATION” ON THE
WELCOME PAGE) .................................................................................................................................................................... 4

2.0

IDENTIFICATION: PREPARER’S PAGE FOR 3RD PARTY......................................... 5

3.0

IDENTIFICATION: INITIAL INFORMATION SECTION ............................................ 6

3.1
3.2
3.3
3.4
3.5

APPLICANT IDENTIFICATION - RETIREMENT/MEDICARE VERSION ................................................................................. 6
APPLICANT IDENTIFICATION - DISABILITY VERSION ..................................................................................................... 7
CONTACT INFORMATION............................................................................................................................................. 9
BIRTH AND CITIZENSHIP INFORMATION..................................................................................................................... 11
MEDICARE ELECTION INFORMATION – AGE 64 AND OLDER ....................................................................................... 13

4.0

IDENTIFICATION: APPLICATION NUMBER ............................................................. 14

4.1
4.2
4.3

RETIREMENT VERSION ............................................................................................................................................. 14
DISABILITY VERSION ................................................................................................................................................ 16
MEDICARE ONLY VERSION ....................................................................................................................................... 18

5.0 IDENTIFICATION: PERSONAL INFO SECTION (RETIREMENT/DISABILITY
ONLY) .............................................................................................................................................. 20
5.1
5.2
5.3

OTHER NAMES AND SSNS ......................................................................................................................................... 20
DISABILITY (RETIREMENT, STARTED FROM RETIREMENT ENTRY POINT) .................................................................... 22
DISABILITY (DISABILITY ALLEGED, STARTED FROM DISABILITY ENTRY POINT) .......................................................... 24

6.0

GENERAL: FAMILY SECTION (RETIREMENT/DISABILITY ONLY) ................... 25

6.1
6.2
6.3

MARRIAGE INFORMATION......................................................................................................................................... 25
PRIOR MARRIAGES ................................................................................................................................................... 27
CHILDREN ................................................................................................................................................................ 31

7.0

GENERAL: MILITARY SECTION (RETIREMENT/DISABILITY ONLY) .............. 36

7.1
7.2

FIRST PARTY ............................................................................................................................................................ 36
THIRD PARTY ........................................................................................................................................................... 37

8.0

GENERAL: EARNINGS SECTION (RETIREMENT/DISABILITY ONLY) .............. 38

8.1
8.2
8.3
8.4
8.5

EMPLOYER DETAILS ................................................................................................................................................. 38
SELF-EMPLOYMENT DETAILS .................................................................................................................................... 40
SUPPLEMENTAL INFORMATION ................................................................................................................................. 42
TOTAL EARNINGS ..................................................................................................................................................... 44
OTHER PENSIONS/ANNUITIES ................................................................................................................................... 49

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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9.0

GENERAL: WHEN TO START BENEFITS (RETIREMENT/DISABILITY ONLY) 51

9.1
9.2
9.3

REDUCED BENEFITS (RETIREMENT ONLY) ................................................................................................................ 51
WHEN TO START BENEFITS (RETIREMENT ONLY) ...................................................................................................... 53
DIRECT DEPOSIT ...................................................................................................................................................... 61

10.0 OTHER BENEFITS: BENEFIT INFO .............................................................................. 63
10.1
10.2

RETIREMENT/DISABILITY VERSION........................................................................................................................... 63
MEDICARE ONLY VERSION ....................................................................................................................................... 66

11.0 OTHER BENEFITS: DISABILITY QUESTIONS (DISABILITY ONLY) ................... 71
11.1
11.2
11.3
11.4

ABILITY TO WORK ................................................................................................................................................... 71
DISABILITY PAYMENTS............................................................................................................................................. 73
DEPENDENTS ............................................................................................................................................................ 75
AUTHORIZATION ...................................................................................................................................................... 77

12.0 REMARKS ............................................................................................................................. 78
12.1
12.2

RETIREMENT/DISABILITY ......................................................................................................................................... 78
MEDICARE ONLY ..................................................................................................................................................... 79

13.0 REVIEW: OVERALL SUMMARY ................................................................................... 80
13.1
13.2
13.3

RETIREMENT VERSION ............................................................................................................................................. 80
DISABILITY VERSION ................................................................................................................................................ 87
MEDICARE ONLY VERSION ....................................................................................................................................... 93

14.0 SUBMIT: SEND THIS APPLICATION ............................................................................ 97
14.1
14.2
14.3

RETIREMENT VERSION ............................................................................................................................................. 97
DISABILITY VERSION ................................................................................................................................................ 98
MEDICARE ONLY VERSION ..................................................................................................................................... 100

15.0 NEXT STEPS: RECEIPT SECTION ............................................................................... 102
15.1
15.2
15.3
15.4
15.5
15.6
15.7
15.8
15.9
15.10
15.11
15.12

RETIREMENT ONLY, FIRST PARTY ........................................................................................................................... 102
RETIREMENT ONLY, THIRD PARTY ......................................................................................................................... 105
RETIREMENT ONLY, CURRENT MARRIAGE AND NO OTHER EVIDENCE REQUIRED, FIRST PARTY ................................ 106
RETIREMENT ONLY, CURRENT MARRIAGE AND NO OTHER EVIDENCE REQUIRED, THIRD PARTY ............................... 107
RETIREMENT ONLY, NO EVIDENCE REQUIRED, FIRST PARTY .................................................................................. 108
RETIREMENT ONLY, NO EVIDENCE REQUIRED, THIRD PARTY ................................................................................ 109
DISABILITY ALLEGED, FIRST PARTY ....................................................................................................................... 110
DISABILITY ALLEGED, THIRD PARTY ...................................................................................................................... 112
MEDICARE ONLY, FIRST PARTY (EVIDENCE REQUIRED) .......................................................................................... 114
MEDICARE ONLY, THIRD PARTY (EVIDENCE REQUIRED) ......................................................................................... 115
MEDICARE ONLY, NO EVIDENCE REQUIRED, FIRST PARTY ..................................................................................... 116
MEDICARE ONLY, NO EVIDENCE REQUIRED, THIRD PARTY .................................................................................... 117

16.0 NEXT STEPS: WHAT’S NEXT SECTION .................................................................... 117
16.1
16.2

RETIREMENT ONLY (NO DISABILITY ALLEGED), FIRST PARTY ................................................................................ 117
RETIREMENT ONLY (NO DISABILITY ALLEGED), THIRD PARTY............................................................................... 119

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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16.3
16.4
16.5
16.6
16.7
16.8

DISABILITY ALLEGED W/ LINK TO 3368 REQUIRED, FIRST PARTY ............................................................................ 120
DISABILITY ALLEGED W/ LINK TO 3368 REQUIRED, THIRD PARTY ........................................................................... 121
DISABILITY ALLEGED BUT NOT CONTINUING TO 3368, FIRST PARTY ...................................................................... 122
DISABILITY ALLEGED BUT NOT CONTINUING TO 3368, THIRD PARTY ...................................................................... 123
MEDICARE ONLY, FIRST PARTY.............................................................................................................................. 124
MEDICARE ONLY, THIRD PARTY ............................................................................................................................ 125

17.0 MESSAGE PAGES ............................................................................................................. 126
MSG005

............................................................................................................................................................................. 126
MSG006 ............................................................................................................................................................................. 126
MSG010 ............................................................................................................................................................................. 127
MSG025 ............................................................................................................................................................................. 128
MSG028 ............................................................................................................................................................................. 128
MSG029 ............................................................................................................................................................................. 129
MSG045 ............................................................................................................................................................................. 129
MSG047 ............................................................................................................................................................................. 130
MSG111 ............................................................................................................................................................................. 130
MSG112 ............................................................................................................................................................................. 131
MSG113 ............................................................................................................................................................................. 132
MSG152 ............................................................................................................................................................................. 133
MSG153 ............................................................................................................................................................................. 134

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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1.0 APPLICATION ENTRY PAGES
1.1

RETIREMENT/MEDICARE BENEFITS

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

Page 1

Title: iClaim Screens for OMB Clearance Package

1.2

DISABILITY BENEFITS

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

Page 2

Title: iClaim Screens for OMB Clearance Package

1.3

USERS COMING FROM THE RETIREMENT ESTIMATOR VERSION

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

Page 3

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1.4

RESTART PAGE (WILL BE SHOWN TO USERS ACCESSING THE
RETIREMENT ESTIMATOR FROM THE WHEN TO START BENEFITS
PAGE AND THEN RETURNING TO THE APPLICATION AND TO USERS
WHO SELECT “CONTINUE APPLICATION” ON THE WELCOME PAGE)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Title: iClaim Screens for OMB Clearance Package

2.0 IDENTIFICATION: PREPARER’S PAGE FOR 3RD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

Page 5

Title: iClaim Screens for OMB Clearance Package

3.0 IDENTIFICATION: INITIAL INFORMATION SECTION
3.1

APPLICANT IDENTIFICATION - RETIREMENT/MEDICARE VERSION

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

Page 6

Title: iClaim Screens for OMB Clearance Package

3.2
3.2.1

APPLICANT IDENTIFICATION - DISABILITY VERSION
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

Page 7

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3.2.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

Page 8

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3.3
3.3.1

CONTACT INFORMATION
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

Page 9

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3.3.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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3.4
3.4.1

BIRTH AND CITIZENSHIP INFORMATION
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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3.4.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

Page 12

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3.5

MEDICARE ELECTION INFORMATION – AGE 64 AND OLDER

3.5.1

FIRST PARTY

3.5.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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4.0 IDENTIFICATION: APPLICATION NUMBER
4.1
4.1.1

RETIREMENT VERSION
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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4.1.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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4.2
4.2.1

DISABILITY VERSION
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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4.2.2

THIRD PARTY

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Last Updated: August 12, 2010

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4.3
4.3.1

MEDICARE ONLY VERSION
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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4.3.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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5.0 IDENTIFICATION: PERSONAL INFO SECTION
(RETIREMENT/DISABILITY ONLY)
5.1
5.1.1

OTHER NAMES AND SSNS
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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5.1.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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5.2

5.2.1

DISABILITY (RETIREMENT, STARTED FROM RETIREMENT ENTRY
POINT)
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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5.2.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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5.3

DISABILITY (DISABILITY ALLEGED, STARTED FROM DISABILITY
ENTRY POINT)

5.3.1

FIRST PARTY

5.3.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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6.0 GENERAL: FAMILY SECTION (RETIREMENT/DISABILITY
ONLY)
6.1
6.1.1

MARRIAGE INFORMATION
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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6.1.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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6.2
6.2.1

PRIOR MARRIAGES
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Last Updated: August 12, 2010

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6.2.2

THIRD PARTY

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Last Updated: August 12, 2010

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6.3
6.3.1

CHILDREN
NO DISABILITY ALLEGED, FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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6.3.2

NO DISABILITY ALLEGED, THIRD PARTY

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Last Updated: August 12, 2010

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6.3.3

DISABILITY ALLEGED, FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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6.3.4

DISABILITY ALLEGED, THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Last Updated: August 12, 2010

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7.0 GENERAL: MILITARY SECTION (RETIREMENT/DISABILITY
ONLY)
7.1

FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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7.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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8.0 GENERAL: EARNINGS SECTION (RETIREMENT/DISABILITY
ONLY)
8.1
8.1.1

EMPLOYER DETAILS
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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8.1.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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8.2
8.2.1

SELF-EMPLOYMENT DETAILS
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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8.2.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Title: iClaim Screens for OMB Clearance Package

8.3
8.3.1

SUPPLEMENTAL INFORMATION
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

Page 42

Title: iClaim Screens for OMB Clearance Package

8.3.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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8.4
8.4.1

TOTAL EARNINGS
RETIREMENT VERSION, FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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8.4.2

RETIREMENT VERSION, THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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8.4.3

DISABILITY VERSION, FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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8.4.4

DISABILITY VERSION, THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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8.4.5

NO WORK OR SELF EMPLOYMENT ALLEGED VERSION, FIRST PARTY

8.4.6

NO WORK OR SELF EMPLOYMENT ALLEGED VERSION , THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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8.5
8.5.1

OTHER PENSIONS/ANNUITIES
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Title: iClaim Screens for OMB Clearance Package

8.5.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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9.0 GENERAL: WHEN TO START BENEFITS
(RETIREMENT/DISABILITY ONLY)
9.1
9.1.1

REDUCED BENEFITS (RETIREMENT ONLY)
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Title: iClaim Screens for OMB Clearance Package

9.1.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Title: iClaim Screens for OMB Clearance Package

9.2
9.2.1

WHEN TO START BENEFITS (RETIREMENT ONLY)
APPLICANT HAS ONE MONTH OF ELECTION OPTION (FIRST PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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9.2.2

APPLICANT HAS ONE MONTH OF ELECTION OPTION (THIRD PARTY)

9.2.3

APPLICANT HAS A DEFAULT MONTH OF ELECTION AND OTHER OPTIONS (FIRST
PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Last Updated: August 12, 2010

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9.2.4

APPLICANT HAS A DEFAULT MONTH OF ELECTION AND OTHER OPTIONS (THIRD
PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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9.2.5

APPLICANT HAS MULTIPLE MONTH OF ELECTION OPTIONS TO CHOOSE FROM BUT
NO DEFAULT (FIRST PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Title: iClaim Screens for OMB Clearance Package

9.2.6

APPLICANT HAS MULTIPLE MONTH OF ELECTION OPTIONS TO CHOOSE FROM BUT
NO DEFAULT (THIRD PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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9.2.7

APPLICANT HAS NOT COMPLETED THE NECESSARY PAGES FOR THEIR MONTH OF
ELECTION OPTIONS TO BE DETERMINED (FIRST PARTY)

9.2.8

APPLICANT HAS NOT COMPLETED THE NECESSARY PAGES FOR THEIR MONTH OF
ELECTION OPTIONS TO BE DETERMINED (THIRD PARTY)

9.2.9

MONTH OF ELECTION SERVICE IS TEMPORARILY UNAVAILABLE (FIRST PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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9.2.10 MONTH OF ELECTION SERVICE IS TEMPORARILY UNAVAILABLE (THIRD PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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9.3
9.3.1

DIRECT DEPOSIT
FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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9.3.2

THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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10.0 OTHER BENEFITS: BENEFIT INFO
10.1 RETIREMENT/DISABILITY VERSION
10.1.1 BENEFIT INFORMATION (FIRST PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Title: iClaim Screens for OMB Clearance Package

10.1.2 BENEFIT INFORMATION (THIRD PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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10.1.3 HEALTH INSURANCE (FIRST PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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10.1.4 HEALTH INSURANCE (THIRD PARTY)

10.2 MEDICARE ONLY VERSION
10.2.1 HEALTH INSURANCE INFORMATION (FIRST PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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10.2.2 HEALTH INSURANCE INFORMATION (THIRD PARTY)

10.2.3 MEDICAID INFORMATION (FIRST PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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10.2.4 MEDICAID INFORMATION (THIRD PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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10.2.5 GROUP HEALTH PLAN INFORMATION (FIRST PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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10.2.6 GROUP HEALTH PLAN INFORMATION (THIRD PARTY)

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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11.0 OTHER BENEFITS: DISABILITY QUESTIONS (DISABILITY
ONLY)
11.1 ABILITY TO WORK
11.1.1 FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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11.1.2 THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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11.2 DISABILITY PAYMENTS
11.2.1 FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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11.2.2 THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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11.3 DEPENDENTS
11.3.1 FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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11.3.2 THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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11.4 AUTHORIZATION
11.4.1 FIRST PARTY

11.4.2 THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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12.0 REMARKS
12.1 RETIREMENT/DISABILITY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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12.2 MEDICARE ONLY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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13.0 REVIEW: OVERALL SUMMARY
13.1 RETIREMENT VERSION
13.1.1 FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Last Updated: August 12, 2010

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Last Updated: August 12, 2010

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13.1.2 THIRD PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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Last Updated: August 12, 2010

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13.2 DISABILITY VERSION
13.2.1 FIRST PARTY

Prepared by: OSES/DBSD

Last Updated: August 12, 2010

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13.2.2 THIRD PARTY

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Last Updated: August 12, 2010

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13.3 MEDICARE ONLY VERSION
13.3.1 FIRST PARTY

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13.3.2 THIRD PARTY

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14.0 SUBMIT: SEND THIS APPLICATION
14.1 RETIREMENT VERSION
14.1.1 FIRST PARTY

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Last Updated: August 12, 2010

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14.1.2 THIRD PARTY

14.2 DISABILITY VERSION
14.2.1 FIRST PARTY

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14.2.2 THIRD PARTY

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14.3 MEDICARE ONLY VERSION
14.3.1 FIRST PARTY

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14.3.2 THIRD PARTY

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15.0 NEXT STEPS: RECEIPT SECTION
15.1 RETIREMENT ONLY, FIRST PARTY

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15.2 RETIREMENT ONLY, THIRD PARTY

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15.3 RETIREMENT ONLY, CURRENT MARRIAGE
EVIDENCE REQUIRED, FIRST PARTY

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Last Updated: August 12, 2010

AND

NO

OTHER

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15.4 RETIREMENT ONLY, CURRENT MARRIAGE
EVIDENCE REQUIRED, THIRD PARTY

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Last Updated: August 12, 2010

AND

NO

OTHER

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15.5 RETIREMENT ONLY, NO EVIDENCE REQUIRED, FIRST PARTY

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15.6 RETIREMENT ONLY, NO EVIDENCE REQUIRED, THIRD PARTY

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15.7 DISABILITY ALLEGED, FIRST PARTY

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\

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15.8 DISABILITY ALLEGED, THIRD PARTY

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15.9 MEDICARE ONLY, FIRST PARTY (EVIDENCE REQUIRED)

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15.10 MEDICARE ONLY, THIRD PARTY (EVIDENCE REQUIRED)

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15.11 MEDICARE ONLY, NO EVIDENCE REQUIRED, FIRST PARTY

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15.12 MEDICARE ONLY, NO EVIDENCE REQUIRED, THIRD PARTY

16.0 NEXT STEPS: WHAT’S NEXT SECTION
16.1

RETIREMENT ONLY (NO DISABILITY ALLEGED), FIRST PARTY

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16.2 RETIREMENT ONLY (NO DISABILITY ALLEGED), THIRD PARTY

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16.3 DISABILITY ALLEGED W/ LINK TO 3368 REQUIRED, FIRST PARTY

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Last Updated: August 12, 2010

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16.4 DISABILITY ALLEGED W/ LINK TO 3368 REQUIRED, THIRD PARTY

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16.5 DISABILITY ALLEGED BUT NOT CONTINUING TO 3368, FIRST PARTY

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16.6 DISABILITY ALLEGED BUT NOT CONTINUING TO 3368, THIRD PARTY

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16.7 MEDICARE ONLY, FIRST PARTY

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16.8 MEDICARE ONLY, THIRD PARTY

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17.0 MESSAGE PAGES
MSG005

MSG006

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MSG010

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MSG025

MSG028

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MSG029

MSG045

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MSG047

MSG111

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MSG112

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MSG113

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MSG152

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MSG153

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Author500267
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File Created2010-08-12

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