Document
Personal Interview - Intranet Screens (field office or National 800 Number)
ICR 202609-0960-010 · OMB 0960-0634 · Object 173100600.
Document Viewer [docx]
Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Personal Interview - Intranet Screens (field office or National 800 Number) |
| Author | Reese, David |
| Last Modified By | Writer |
| File Modified | 2026-04-28 |
| File Created | 2026-10-30 |
| Conversion State | complete |
Extracted Text
PEMU-FACSIMILE:
LnNo
0
1
1 2 3 4 5 6 7 7
234567890123456789012345678901234567890123456789012345678901234567890123456789
8
0
1
C
POS 4.0 POS MENU PEMUSM50
2
0
AUTHORIZER: SSSSSSSSSS SSSSSSSSSS FIELD OFFICE: SSS MOD: SS
3
l
4
u
*SELECT: X 1=ESTABLISH 5=FUTURE USE
5
m
2=UPDATE 6=FUTURE USE
6
n
3=QUERY 7=FUTURE USE
7
*
4=FUTURE USE 8=FUTURE USE.
8
o
9
n
*NH SSN: XXXXXXXXX PIC: XXX
10
e
11
12
r
UNIT: XXXXXX
13
e
14
s
BENEFICIARY SAME AS REPORTER (Y/N): X
15
e
REPORTER FIRST NAME: XXXXXXXXXX REPORTER LAST NAME: XXXXXXXXXXXXXXXXXXXX
16
r
RELATIONSHIP TO BENEFICIARY: XXXXXXXXXXXXXXXXX
17
v
18
e
REPORTER DAYTIME PHONE: XXXXXXXXXX
19
d
20
21
22
23
24
**************(Line 24 Reserved for Operating Systems Information)***********
PESL-Facsimile:
LnNo
0
1
1 2 3 4 5 6 7 7
234567890123456789012345678901234567890123456789012345678901234567890123456789
8
0
1
C
POS POS SELECTION LIST PESL
2
0
NH SSN: SSSSSSSSS NH NAME: SSSSS SSSSSSSSSS
3
l
SELECT ALL: XX XX
4
u
[ PIC LAF DE SSI PC BENEFICIARY NAME DOB
5
m
SSS SS S SSS SS SSSSSSSSSS S SSSSSSSSSSSS SSSSSSSS XX XX XX XX XX XX
6
n
SSS SS S SSS SS SSSSSSSSSS S SSSSSSSSSSSS SSSSSSSS XX XX XX XX XX XX
7
*
SSS SS S SSS SS SSSSSSSSSS S SSSSSSSSSSSS SSSSSSSS XX XX XX XX XX XX
8
o
SSS SS S SSS SS SSSSSSSSSS S SSSSSSSSSSSS SSSSSSSS XX XX XX XX XX XX
9
n
SSS SS S SSS SS SSSSSSSSSS S SSSSSSSSSSSS SSSSSSSS XX XX XX XX XX XX
10
e
SSS SS S SSS SS SSSSSSSSSS S SSSSSSSSSSSS SSSSSSSS XX XX XX XX XX XX
11
SSS SS S SSS SS SSSSSSSSSS S SSSSSSSSSSSS SSSSSSSS XX XX XX XX XX XX
12
r
13
e
1=ADDR/DIR DEP/TEL 11=CHILD RELATIONSHIP 21=ALIEN TAX WITHHOLDING
14
s
2=NAME CORRECTION 12=NONRECEIPT 22=FOREIGN ACTIONS
15
e
3=DEATH/RESURRECT 13=WORK REPORTS 23=CITIZENSHIP
16
r
4=MARRIAGE/DIVORCE 14=HEALTH INS ENROLLMENT 24=LAWFUL PRESENCE
17
v
5=MISC SUSP/TERM/REINST 15=HEALTH INS REPLACMNT CARD 25=CERT OF ELECTION
18
e
6=DISABILITY CESSATION 16=FUTURE USE 26=STUDENT
19
d
7=PROVISIONAL PAYMENTS 17=PAY CYCLE 27=GOVT PENSION OFFSET
20
8=CDR SUSPEND/RESUME 18=WAGE/EMPOY INFO AUTH 28=AUTHORIZED REP
21
9=DEV REP SUSP/REINSTATE 19=MILITARY SERVICE UPDATE 29=LANGUAGE
22
10=CHILD IN CARE ISSUES 20=VOLUNTARY TAX WITHHOLDING 30=SPECIAL NOTICE OPTION.
23
**************(line 23 reserved for applications information)*****************
24
**************(Line 24 Reserved for Operating Systems Information)***********
PEAD-Facsimile:
LnNo
0
1
1 2 3 4 5 6 7 7
234567890123456789012345678901234567890123456789012345678901234567890123456789
8
0
1
C
POS POS ADDRESS/DIRECT DEPOSIT/PHONE PEAD
2
0
NH: SSSSSSSSS SSSSS SSSSSSSSSS BN: SSSSSSSSS SSSSS SSSSSSSSSS PIC: SSS
3
l
PAY CYCLE: SSSSSSSSSSSSSSSS CYC RUN PROC DT: SSSSSS CYC REASON: SSSSSSSSSSSSSS
4
u
LEGEND 1: SSSSSSSSSSSSSSSSSSSSSS LEGEND 2: SSSSSSSSSSSSSSSSSSSSSS
5
m
LEGEND 3: SSSSSSSSSSSSSSSSSSSSSS LEGEND 4: SSSSSSSSSSSSSSSSSSSSSS
6
n
*ADDRESS 1: PPPPPPPPPPPPPPPPPPPPPP ADDRESS 2: PPPPPPPPPPPPPPPPPPPPPP
7
*
ADDRESS 3: PPPPPPPPPPPPPPPPPPPPPP ADDRESS 4: PPPPPPPPPPPPPPPPPPPPPP
8
o
*CITY: PPPPPPPPPPPPPPPPPPPPPP STATE: PP ZIP: PPPPP
9
n
STATE & COUNTY CODE : PPPPP DISTRICT OFFICE CODE: PPP
10
e
COUNTRY: PPPPPPPPPPPPPPPPPPPPPP CONSULAR CODE: PPP
11
FOREIGN POSTAL ZONE: PPPPPPPPPPPPPPP GEOGRAPHIC CODE: PPPPP
12
r
13
e
14
s
*SELECT CONTACT TYPE:P 1=TELEPHONE 2=INOFFICE 3=VIDEO 4=MAIL/DESK WORK.
15
e
DIRECT DEPOSIT ROUTING TRANSIT NUMBER: PPPPPPPPP ACCOUNT TYPE (C/S): P
16
r
DEPOSITOR ACCOUNT NUMBER: PPPPPPPPPPPPPPPPP CANCEL DIRECT DEPOSIT (Y): A
17
v
DIRECT EXPRESS (Y):A DELETE FUTURE BANK DATA(Y): A
18
e
SELECT PAYMENT EFFECTIVE DATE: X 1=SS/SS/SSSS 2=SS/SS/SSSS.
19
d
SELECT PHONE CODE: P 1=HOME 2=WORK 3=NONE 4=UNK 5=OTH 6=ATTY 7=MOBILE.
20
PHONE NUMBER: PPPPPPPPPPPPPPP SELECT PHONE TYPE: P 1=DOMESTIC 2=FOREIGN.
21
DOES All THE DATA ON THIS SCREEN APPLY TO D/E SSN SSSSSSSSS SSS (Y/N) :A
22
ADD/REVIEW FUTURE EVENTS (Y): P DELETE (Y): A TRANSFER TO: XXXX
23
24
**************(Line 24 Reserved for Operating Systems Information)***********
PEAF-FACSIMILE:
LnNo
0
1
1 2 3 4 5 6 7 7
234567890123456789012345678901234567890123456789012345678901234567890123456789
8
0
1
C
POS FUTURE POS ADDRESS/DIRECT DEPOSIT/PHONE PEAF
2
0
NH: SSSSSSSSS SSSSS SSSSSSSSSS BN: SSSSSSSSS SSSSS SSSSSSSSSS PIC: SSS
3
l
PAY CYCLE: SSSSSSSSSSSSSSSS CYC RUN PROC DT: SSSSSS CYC REASON: SSSSSSSSSSSSSS
4
u
LEGEND 1: SSSSSSSSSSSSSSSSSSSSSS LEGEND 2: SSSSSSSSSSSSSSSSSSSSSS
5
m
LEGEND 3: SSSSSSSSSSSSSSSSSSSSSS LEGEND 4: SSSSSSSSSSSSSSSSSSSSSS
6
n
ADDRESS 1: PPPPPPPPPPPPPPPPPPPPPP ADDRESS 2: PPPPPPPPPPPPPPPPPPPPPP
7
*
ADDRESS 3: PPPPPPPPPPPPPPPPPPPPPP ADDRESS 4: PPPPPPPPPPPPPPPPPPPPPP
8
o
CITY: PPPPPPPPPPPPPPPPPPPPPP STATE: PP ZIP: PPPPP
9
n
STATE & COUNTY CODE : PPPPP DISTRICT OFFICE CODE: PPP
10
e
COUNTRY: PPPPPPPPPPPPPPPPPPPPPP CONSULAR CODE: PPP
11
FOREIGN POSTAL ZONE: PPPPPPPPPPPPPPP GEOGRAPHIC CODE: PPPPP
12
r
FUTURE EFFECTIVE DATE (MMCCYY): PPPPPP FUTURE MOVE DATE (MMDDCCYY): PPPPPPPP
13
e
CANCEL ADDRESS (Y): A
14
s
SELECT CONTACT TYPE:_ 1=TELEPHONE 2=INOFFICE 3=VSD 4=Mail/Desk work.
15
e
DIRECT DEPOSIT ROUTING TRANSIT NUMBER: PPPPPPPPP ACCOUNT TYPE (C/S): P
16
r
DEPOSITOR ACCOUNT NUMBER: PPPPPPPPPPPPPPPPP CANCEL DIRECT DEPOSIT (Y): A
17
v
FUTURE EFFECTIVE DATE (MMCCYY): PPPPPP
18
e
SELECT PHONE CODE: P 1=HOME 2=WORK 3=NONE 4=UNK 5=OTHER 6=ATTY 7=MOBILE.
19
d
PHONE NUMBER: PPPPPPPPPPPPPPP SELECT PHONE TYPE: P 1=DOMESTIC 2=FOREIGN.
20
FUTURE EFFECTIVE DATE (MMDDCCYY): PPPPPPPP CANCEL PHONE (Y): A
21
DOES All THE DATA ON THIS SCREEN APPLY TO D/E SSN SSSSSSSSS SSS (Y/N) :A
22
REVIEW CURRENT EVENTS (Y): A DELETE (Y): A TRANSFER TO: XXXX
23
24
**************(Line 24 Reserved for Operating Systems Information)***********