Internet Social Security Benefits Application (iClaim) - Foreign Applicants Third Party (SSA-16)

September Release Internet Claim (iClaim) Screen Package
Terms of Service Screen (ToS)
We display the ToS screen upon all initial entries to the internet benefit application. All
individuals must accept the ToS to proceed to the application process. On this screen, we are
revising the language under “Information about Social Security’s Online Policies” to include a
link to the agency’s Internet Privacy Policy and moving this informational section to below the
checkbox.

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September Release Internet Claim (iClaim) Screen Package
Supplemental Information

This screen asks the individual to provide supplemental information about work and earnings.

Individuals who did not
enter iClaim through
their “my Social
Security” online portal
will continue to receive
the screen with all the
options.

We are modifying this screen only for individuals who visited and entered iClaim through their
“my Social Security” online portal. Individuals who provided a response will receive an
informational message informing them that the prefilled option is based on the answer they
previously provided on their “my Social Security.” This screen will not display the option to
select “Not sure or I do not have a statement” as a copy of their statement was provided on their
online portal.

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September Release Internet Claim (iClaim) Screen Package
Start Retirement Benefits

We are modifying this screen to remove instructions on accessing the Retirement Estimator (RE)
tool that is decommissioned. We added language to inform applicants that they can access their
benefit estimate by signing into their personal my Social Security account.

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September Release Internet Claim (iClaim) Screen Package
Overall Summary for Benefit Application
This screen provides a summary of the information the individual provided and allows the
opportunity to go back and “edit” it as needed.

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September Release Internet Claim (iClaim) Screen Package
Overall Summary for Benefit Application (cont.)
We are revising the Overall Summary screen to display information about the new Application
For Medicare Part A and Part B Special Enrollment Period - Exceptional Circumstances (CMS10797) (OMB 0938-New) for when individuals opt to apply for an SEP at the same time they are
completing the Retirement or Medicare application via iClaim. For these individuals, this screen
will include a new sub header informing them of their selections for this form and a revised
Electronic Signature Statement. This change will be effective December 2022

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September Release Internet Claim (iClaim) Screen Package
Electronic Signature Agreement (with Special Enrollment Period (SEP)
Medicare Form)
This screen appears at the bottom of the Overall Summary for Benefit Application screen. First
party applicants review the information and checks the box “I agree with the Electronic
Signature Agreement above.” We updated this screen to ensure individuals are clearly informed
that as part of this online submission, they are completing more than one form and providing one
signature for both a Social Security benefit application and the Centers for Medicare and
Medicaid Services (CMS-10797) form.

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September Release Internet Claim (iClaim) Screen Package
Electronic Signature Agreement (without SEP Form)
We are revising the one statement highlighted above from passive voice to active voice for
greater clarity and plain language purposes.

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September Release Internet Claim (iClaim) Screen Package
Example screen of language changes for 3rd party Screens
We are revising the iClaim screens that third-parties complete to replace gender-specific
pronouns. We are updating these screens in support of Executive Order (EO) 13988, “Preventing
and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation.” This
language aligns with already implemented language in our public SSA web pages. Many of the
screens had minimal changes, we are providing this screen which had the most changes as
example.

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