3rd Party iClaim

Social Security Benefits Application

iClaim Screens - Current and Revised (select screens only)

3rd Party iClaim

OMB: 0960-0618

Document [pdf]
Download: pdf | pdf
Current Screen
Benefit Information for 1st party
(CA resident with intent to file for SSI)

Current Screen
Benefit Information for 3rd party
(CA resident with intent to file for SSI)

Modified Screen
Benefit Information for 1st party
(CA resident with intent to file)

Modified Screen
Benefit Information for 3rd party
(CA resident with intent to file)

Modified Screen
Benefit Information for 1st party
(CA resident with everyone in household filing for SSI)

Modified Screen
Benefit Information for 3rd party
(CA resident with everyone in household filing for SSI)

Modified Screen
Benefit Information for 1st party
(CA resident with “No” to everyone in household filing for SSI)

Modified Screen
Benefit Information for 3rd party
(CA resident with “No” to everyone in household filing for SSI)


File Typeapplication/pdf
Author701232
File Modified2019-02-11
File Created2019-02-11

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