Internet Social Security Benefits Application (iClaim) - Domestic Applicants First Party (SSA-1)

iClaim Screen Package
The Internet Claim (iClaim) is an online platform that mirrors the MCS format. The
public can use iClaim to apply for retirement, wife or husband, and disability insurance
benefits. iClaim is institutive and depending on the initial answer, iClaim presents
applicants with interactive screens, ensuring they only respond to relevant questions
based on his or her situation. iClaim also provides the option to use the retirement
application as an application for wife’s or husband’s benefits. After completing the
Internet application, claimants or their third-party respondents can submit it electronically
to SSA, avoiding the need to visit an SSA office. Third-party iClaim respondents are
individuals who complete and submit an online claim for a claimant to create a protective
filing. A third-party iClaim respondent cannot electronically sign the online application
for the claimant.
First-party iClaim respondents are individuals (claimants) who complete the benefit
application questions, electronically sign, and submit the application online on their own
behalf. Technician will then review the information and contact (if needed) the claimant
to submit supplementary supporting documents (e.g., medical evidence for disability
benefits applications) to finalize the process.
Third-party respondents follow the same process to answer and complete the answers
in the Internet application except for 1) providing information about who is filling out the
information (see page #5) and 2) signing on behalf of the claimant (see page #33). Upon
submission, SSA mails the paper application summary directly to the claimant. The
claimant must review, correct any erroneous information, sign the application summary
and mail it back to SSA. That process confirms the information and their intent to file for
benefits. The application summary also provides instructions for individuals to contact us
via telephone to verify and confirm the information instead of mailing the paper version
back. If a claimant opts to call us, the technician will attest that he or she spoke to the
claimant and provided verbal confirmation of the information (i.e. signature by
attestation).
The following screen are specific to the first-party respondents as the third-party screens
are the same questions but using a different pronoun when asking the question (e.g., what
is your mailing address? vs. what is John Doe mailing address?)

1

Welcome Page

This is the welcome page a user will see when they indicates he or she wants to file for benefits
online or return to an application the user previously started and saved.

2

iClaim Privacy Act Statement

3

Apply for Benefits – Applicant Information Page (1st Party)

This screen is completed by the applicant. The questions on this screen establishes the claim type
and collects the application questions that identify the applicant.

4

Apply for Benefits – Preparer’s Contact Information (3rd Party)

This screen is completed by the preparer (3rd party) to collect questions that identify the preparer,
also identfied as the 3rd party.

5

Apply for Benefits – Contact Information Page (1st Party)

This information is provided by the applicant on identifying information.
6

Apply for Benefits – You have additional options page

This screen comes up only when the user selects a non-Enlish language as their preferred
language in the contact information screen (see page#6). The screen provides the option to
continue in English or additional options to file for benefits such as scheduling an online
appointment with iAppointment or calling us.

7

Re-entry Number (1st party)

This screen comes up after the user provided all the basic contact information and the system
creates the re-entry number to save the information if he or she wants to come back to the
application to complete the process.

8

Birth and Citizenship Information (1st Party)

The applicant provides birth and citizenship information.

Apply for Benefits – Disability Only request for reduced Retirement Benefits
(1st Party)

The applicant, if filing for Disability Benefits only, may request reduced retirement benefits if
between the age 61 and 8 months and month before full retirement age.
9

Marriage Information (1st Party)

The applicant answers questions as to current and prior marriages that lasted at least 10 years, or
ended in death.

10

Prior Marriage Details (1st Party)

The applicant provides information about the prior marraiges for which they answered yes to the
Marriage Information questions.

11

Children of NH filing for either Retirement or Disability Benefits (1st Party)

12

Military Details (1st Party)

Upon approval of the renewal of the OMB Package, we will be removing the question, “Were
you in the U.S. Military Service Prior to 1968?” and removing subsequent request for details of
military service. This question is no longer required in the application.

13

Employer Details (1st Party)

The applicant answers questions on if they worked for an employer in the past two years.

14

If the applicant answers “yes” to working in the current year or prior year, the applicant will
answer questions on the Employer.

15

Self Employment Details (1st Party)

The applicant provides a “yes” or “no” answer if they were self-employed in the current year or
prior year.

16

Supplemental Information – Foerign Social Security (1st party)

This screen is for the user to provide information about foreign Social Security benefits, if they
answer yes, a technician will contact the user to develop for evidecne of those benefits.

17

Total Earnings (1st Party)

If the applicant answered “yes” on the Employer Details screen to having earnings in the current
year or prior year, the applicant must indicate the total wages for each year.

18

Other Pensions or Annuities Not Covered By Social Security or Railroad
questions (1st Party)

The applicant answers if they ever worked in a job where Social Security taxes were not
deducted. The applicant also answers the questions about work for the Railroad (if he or she
indicated that was married, the spouse or prior spouse question generates)

19

Reduced Benefits – Retirement Benefits only (1st Party)

The applicant, when filing for Retirement Benefits, can select reduced benefits. Depending on
the response, the next screen will appear for him or her to select the month they want to start
benefits.

20

When to Start Retirement Benefits – Retirement Only (1st Party)

The applicant, when filing for Retirement Benefits, has a default benefit start date, but has
options to choose another benefit start date.

21

Direct Deposit (1st Party)

The applicant answers “yes” or “no” to owning a bank account.

22

Benefit Information (1st party)
With everyone in household filing for SSI

When the applicant selects “yes” for the question, “Do you intend to file for SSI” the second
question about the SSI household will populate to the screen. A new message that contains
required filing and benefit information for SNAP will appear by answering “yes” to this
question.

23

Medicare Coverage (1st Party)

If the applicant is 64 years and 8 months or older, the system generates the Medicare screen for
the user to answer questions to Medicare Part B coverage and Medicaid coverage.

Group Health Plan Information if Claimant is 64 years 8 months or older (1st
Party)

If the applicant is 64 years 8 months or older, the applicant answers question, “are you covered
under a Group Health Plan?”

24

Ability to Work – Disability Benefits Only (1st Party)

This screen only populates if the user indicated that he or she had a disability under the
Applicant Information Page (see page #4).

25

Workers’ Compensation/ Public Disability Benefits for Disability Only (1st
Party)

This screen propagates if the user answers “yes” on the Ability to Work Screen question, “Are
your illnesses, injuries, or conditions related to work in any way?” The applicant answers
questions regarding workers’ compensation and public disability benefits.

26

Other Dependents for Disability Benefits Only (1st Party)

This screen populates if the user indicates that he or she has children as we need information
about the one-half support to determine if the child qualifies for benefits.

27

Overall Summary for Benefit Application

28

29

30

This screen provides a summary of the information provided in the application.

31

Electronic Signature Agreement (1st party)

This screen appears at the bottom of the Overall Summary for Benefit Application Screen. When
a first party applicant reviews the information and agrees to the information provided, the
applicant reviews the agreement and checks the box “I agree with the Electronic Signature
Agreement above”

32

Electronic Agreement (3rd party)

This screen appears at the bottom of the Overall summary for Benefit Application Screen after
the 3rd party responder reviews the information provided. The 3rd party then has the option to
submit the application by clicking “Submit Now”, “Save and Exit” to return at at later time, or
“Previous” to return to the summary page.

33