SSI Online Appointment Screens - 1st Party Path (Revised)

Final 5-23-22 1st Party screens

Screen #1 - Welcome Page Screen

This is the “Welcome Page” where individuals receive information about the process. We revised
the headers of this tool to replace “File” with “Apply” as suggested by public comments received
during the emergency OMB clearance. We also made the same changes within the pages based on
the appropriate context of the statement.
Terms of Service (ToS) link

The ToS link informs individuals of various privacy and security aspects before the individual
enters the Government information system. The ToS acknowledges that we may monitor activity
within the online system. The pop-up message also provides a direct link to SSA’s Internet Privacy
Policy that explains the agency’s online information practices.
We removed the “Back” and “Exit” button options and replaced them with a single “Close” option
at the bottom of this screen to simplify the screen, as both options led to the same result: a return to
the welcome page.
Once individuals close the ToS pop-up message, they can select the “Start” button to proceed in the
tool.
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Screen #2 - Privacy Act (PA) Statement page

Due to 508 compliance issues, we converted the link for the PA Statement into a single page so
mobile users can read and review it. The prior link included within the welcome page generated a
pop-up message, which generated issues reports.

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Screen #3- Selecting path for users (Who is Scheduling)

We ask individuals to indicate who they are answering the questions about. If they select the
“Yourself” option or the “Someone else who is with you as you answer these questions” option,
individuals will continue on the path for “First-Party” users.
First Party user is an individual who can sign an application on their own behalf. If the individual
selects any other option, the system presents the Assistor (Third-Party) path. Although individuals
making the request for their child or for an incompetent adult whose care they are responsible for
are considered “First-Party users” in some contexts because they might be able to sign the benefit
application on the claimant’s behalf, for the purpose of the description of this online tool, we
include them on the “Third-Party Path” screen package as it follows the same pathing for questions
and format.
Based on public comments submitted during the emergency OMB clearance, we revised this screen
to separate “An incompetent adult whose care you are responsible for or for whom a court has
appointed you the legal representative” into its own standalone radio button option.

Note: All fields with an asterisk (*) are mandatory fields and individuals must enter a response in
order to proceed to the next screen. If an individual does not enter or select a response, the system
provides an alert for individuals to take action and correct the information.

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Screen #4 - Personal Information

Individuals must provide their personal contact information (name, phone number, and mailing
address) in order to submit their appointment request and receive an appointment confirmation via
mail. If an individual voluntarily provides an email address, we will email the appointment
confirmation as well.
Based on a public comment about the contact information, we split the prior information message
into two new informational messages to inform users about the importance of the information and
why we are collecting a phone number, mailing address, and optional email address.
Individuals not entering the required information or selecting “Exit” receive the following alerts:

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Screen #5 - Date of Birth and #6 Social Security Number

Upon entering their personal contact information and selecting “Next,” the individual is asked to
provide their date of birth and Social Security number. We require this information to establish the
appointment under the correct record and to alert us if there are special internal indicators that need
further evaluation. In addition, we use the provided date of birth to determine if the individual is
under the age of 13 years old to ensure compliance with the Children’s Online Privacy Protection
Act (COPPA) and OMB M-03-22 guidelines. Individuals under the age of 13 who attempt to use
this tool will receive the following alert to contact us for additional assistance.

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Screen #7 - Disability Information

We request individuals to indicate if they have a disability or if they are blind. If they select “Yes”
to the first question, the system presents a third question to provide us with an estimated date of
when the condition began. This information, along with the date of birth, helps us to determine the
type of appointment needed (e.g., aged, adult, or child appointment). In addition, we provide a
message about the option to request special notices for those with a visual impairment.
Individuals selecting “No” to the first two questions receive the following alert advising them of
the SSI eligibility requirements. The alert does not prevent individuals from continuing to request
an appointment, as individuals are able to file an application to obtain a formal determination from
SSA about whether they may be entitled to benefits.

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Screen #8 - Language Preference

This screen provides a scroll down with 89 languages and an option for “other” for the individual to
indicate their language preference. We request information about the language preference for both
speaking and reading. We use the information about the speaking language preference to provide
interpreters during the appointment interview. We use the information about reading language
preference to provide reading materials (if available) about our programs and certain notices.
For consistency purposes throughout the tool, we revised the language in the informational
message to explain to the user that the language selected helps us to communicate with them in the
appointment to apply for benefits.

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Screen #9 - Special Circumstances

This screen offers the option for individuals to choose from a list of special circumstances that may
apply to them. We use this information to provide either expedited appointments or additional
assistance as needed during the appointment interview.
Based on a public comment provided during the OMB emergency clearance, we added language to
the “Need visual accommodation” checkbox to include a list of available options to the user.

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Screen #10 - Review and Submit

This screen provides the opportunity for the individual to review all the provided information prior
to submission. If individuals need to correct any information, they can go back to the previous
pages to edit the answers. Individuals receive the following alert if the electronic signature
agreement box is not checked.

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Screen #11 - Appointment Request Received

After the individual submits the requested information, and the information passes certain internal
checks, the system displays this screen to inform the individual that SSA has received the
information. This screen also provides the specific date the individual submitted the appointment
request and the dates that an application must be submitted by to avoid losing benefits.
For consistency within the tool and other related publications, we updated the language on this screen
as follows:
•

Replaced all occurrences of the word “file” with “apply” or “submit” based on the
appropriate context of the statement.

•

Added “other Social Security benefits” where applicable.

•

Revised the last sentence on the screen to read “Special notice options are available for
people who are blind or visually impaired to receive notices and other communications from
Social Security in formats other than standard print. You can request a Special Notice Options
that meet your needs.”

•

Added the new section: “How can I prepare for my appointment?” to provide additional
information about the medical portion of the process. The information on this section is
dynamic and is displayed based on the information provided (e.g., date of birth, disabled,
etc.).

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Screen #12 - Alerts
If the information provided does not pass the internal checks, the system provides the following
alert informing the individual that we cannot process the request and they can call us.

Our systems undergo daily maintenance during certain timeframes. During this “downtime,” our
systems may be interrupted and unavailable. Individuals trying to use the tool during the
“downtime” will receive the message below.

Individuals attempting to use this online tool within 15 minutes of the “downtime” will receive the
screen below to alert them about the system interruption.

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Screen #12 – Alerts cont.
To improve the functionality of the tool, avoid duplicative efforts, and expedite the process for
individuals requesting appointments, we updated the system to identify individuals already
receiving benefits. Individuals already receiving benefits will receive an alert to contact us.

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Screen #13 - Email Confirmation Message

Once the information is transmitted to SSA, and if an email address was provided, individuals will
receive an email confirmation with the information shown above.
For consistency, we updated the language from “file” to “apply” or “submit” based on the
appropriate context of the statement.

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