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pdfiClaim 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.
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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.
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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).
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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.
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Modified Screen#5
Supplemental information Screen
EW
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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.
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Modified Screen#6
Total Earnings Screen
EW
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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.
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Modified Screen #7
Other Pensions/Annuities Screen
We are adding “U.S.” to the current question for clarification purposes.
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Modified Screen #8
Reduced Benefits Screen
We are adding “permanent” to the current statement for clarification purposes.
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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.
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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.
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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.
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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).
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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.
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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.
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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.
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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).
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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.
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Modified Screen #10
Health Insurance Screen
We added “current” to the existing question for clarification purposes.
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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.
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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.
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File Type | application/pdf |
File Title | Microsoft Word - 4-13-12 final iClaim_Screen_Package.docx |
Author | 177717 |
File Modified | 2013-08-06 |
File Created | 2012-04-17 |