Personal Interview - Intranet Screens (field office or National 800 Number)

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Electron Form 101 (EF101): Screen Package
Table of Contents
1. SSA Main Menu .............................................................................................................................................................. Error! Bookmark not defined.
2. Title II Postentitlement Menu ........................................................................................................................................ Error! Bookmark not defined.
3. Electronic Form 101 Menu............................................................................................................................................. Error! Bookmark not defined.

EF101
SSA MAIN MENU
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1 2345 678 901 234 56 78 9012 345 678 901 23 45 6789 012 345 678 90 12 3456 789 012 345 67 89 0123 456 789
C
SS A MENU
MA IN
0
L
S ELE CT TH E DESI RED FU NCT IO N: XX
U
M
1. TIT LE II/ IN IT IAL CLA IMS
1 9. CPS DA TA I NPUT S/Q UER IES
N
2. TIT LE II/ PE
2 0. DOO RS
*
3. TIT LE XVI /I C CLAI MS AND PE
2 1. RRB DA TA I NPUT S
O
4. SHA RED PR OC ES SES
2 2. ALT ERN AT ED M OD E F ACI LIT Y
N
5. ENU MER ATI ON
2 3. REP RES EN TA TIVE PA YEE
E
6. DEB T M ANA GE ME NT
2 4. MOD ERN IZ ED DEV ELO PME NT WO RK SHEE T
7. TIT LE II/ IN TE RACT IVE CO MPS
2 5. WMS LI ST IN GS
R
8. TIT LE XVI /I NT ERAC TIV E C OMP S
2 6. PC ACT IO N CONT ROL SY STE M
E
9. MAS TER FI LE Q UERY
2 7. PAY MEN TS O UTSI DE TIT LE II S YSTE M
S 10. MAC ADE
2 8. DRU G A DD IC TION AN D A LCO HO LI SM
E 11. APP OIN TME NT /R EFER RAL /LE ADS
2 9. THI RD PA RT Y PA YME NT SYS TE M
R 12. EAR NIN GS MO DE RNIZ ATI ON
3 0. COM MON T IC KLE
V 13. INT EGR ITY R EV IEW
3 1. ONL INE R ET RIEV AL SYS TEM
E 14. RSD HI DAT A IN PUTS
3 2. DIS ABI LI TY CON TRO L F ILE
D 15. SSI DA TA IN PU TS
3 3. PRI SON S YS TEM/ FUG ITI VE FE LO NS
16. ADM INI STR AT IV E AP PLI CAT ION S
3 4. NET WOR K ST ATUS
17. OHA DA TA IN PU TS/Q UER IES
3 5. UNV ERI FI ED PRI SON ER SYS TE M
18. NDD SS MAS TE R FILE ME NU
9 9. RET URN
**** *** *** *** *( LI NE 2 3 R ESE RVE D FO R AP PLI CAT ION S IN FORM A TI ON) *** ** ** **** *** * **
**** *** *** *** *( LI NE 2 4 R ESE RVE D FO R OP ER A TIN G S YS TE MS I NFO RM A TIO N) ** **** *** **
SCREEN FR
MSOM

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EF101

TITLE II POSTENTITLEMENT MENU

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C
TIT LE I I PO STE NTI TLE ME NT MEN U
T2 PE
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* SEL EC T: X
U
1=P OS T ENTI TLE MEN T O N - LI NE S YST EM (PO S)
M
2=M IS CE LLAN EOU S O N -L IN E EDIT ED TRA NSA CT IO NS ( MON ET)
N
3=I NC OM E RE LAT ED MED IC AR E AD JUS TME NT AM OU NT ( IR M AA)
*
4=E LE CT RONI C F ORM 10 1 (E F101 ).
O
N
E
R
E
S
E
R
V
E
D

**** *** *** *** *( LI NE 2 3 R ESE RVE D FO R AP PL I CAT ION S IN FORM ATI ON ) *** ** ** **** *** ***
**** *** *** *** *( LI NE 2 4 R ESE RVE D FO R OP ER A TIN G S YS TE MS I NFO RM A TIO N) ** **** *** **
SCREEN FR
MSOM

This screen is the menu to the Electronic Form 101 system that manually processes initial,
subsequent, or amended awards. Data entered into EF101 will be edited and propagated into
MACADE. This process should eliminate much of the payment center efforts in double keying
of identical information.

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EF101

ELECTRONIC FORM 101 MENU
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1 2345 678 901 234 56 78 9012 345 678 901 23 45 6789 012 345 678 90 12 3456 789 012 345 67 89 0123 456 789
C EF10 1
ELE CTR ON IC FOR M 1 01 MEN U
EFME NU FWM
0
L
*NH SS N: 99 99 9999 9
*U NI T: XX XXX X
FIE LD OFF ICE : SS S
U
M
*SE LEC T M OD E: 9
1 =ES TA BL ISH
2=U PDA TE
3= QUE RY.
N
*
*SE LEC T F UN CT ION: X
1 =IN IT IA L AW ARD
O
2 =SU BS EQ UENT AW ARD
N
3 =AM EN DE D AW ARD
E
4 =AD JU DI CATE EF 101
5 =TR AN SF ER E F10 1
R
6 =DE LE TE EF1 01
E
7 =UN LO CK EF1 01
S
8 =PR IN T.
E
R
V
E
D

**** *** *** *** *( LI NE 2 3 R ESE RVE D FO R AP PL I CAT ION S IN FORM ATI ON ) *** ** ** **** *** ***
**** *** *** *** *( LI NE 2 4 R ESE RVE D FO R OP ERA TIN G S YS TE MS I NFO RMA TIO N) ** **** ** * **
SCREEN FR
MSOM

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EF101
PAYMENT INFORMATION
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2345 678 901 234 56 78 9012 345 678 901 23 45 6789 012 345 678 90 12 3456 789 012 345 67 89 0123 456 789
EF10 1
P AY ME N T I NFO RMA TIO N
EFMA IL FWB
NH S SN: SS S S S SS SS
N H NAME : S SSS SSS SS S S SS SSS SSS SSS SS SS SSSS S S SSS
BN S SN: SS S S S SS SS
BIC : S SS
B N NAME : S SSS SSS SS S S SS SSS SSS SSS SS SS SSSS S S SSS
*BAN K A CCO UNT ( Y/ N): X
* DI RE CT EXP RES S ( Y/N ): X
TRN: 99 999 999
CDC: 9
DPC ( C/ S): X
D AN: X XX XXXX XXX XXX XXX X
*L EGE ND 1: XX XX XXXX XXX XXX XXX XX XX X
L EGE ND 2: X XXXX XXX XXX XXX XX XX XXXX
L EGE ND 3: XX XX XXXX XXX XXX XXX XX XX X
L EGE ND 4: X XXXX XXX XXX XXX XX XX XXXX
*AD DRE SS 1: XX XX XXXX XXX XXX XXX XX XX X
AD DRE SS 2: X XXXX XXX XXX XXX XX XX XXXX
AD DRE SS 3: XX XX XXXX XXX XXX XXX XX XX X
AD DRE SS 4: X XXXX XXX XXX XXX XX XX XXXX

R
* CIT Y: XX XX XXXX XXX XXX XXX XX XX X
ST ATE : X X
ZI P: 999 99
E
STA TE AN D COUN TY COD E: XX XX XX
S
COU NTR Y: XX XX XXXX XXX XXX XXX XX XX X
PO STA L Z ON E: XXX XXX XXX XXX XX X
E
CON SUL AR CO DE : 99 9
GE OGR APH IC C ODE: XX XXX X
R
V *ENT ER PHO NE CO DE : 9
1=H OME
2=W ORK
3= NONE
4= UN KN OWN
E
5=O THE R
6=A TTO RNE Y
7= MOBI LE.
D
PHO NE: 99 999 99 99 9
FOR EIG N PH ONE: 99 999 999 99 99 999
RES IDE NT FO: X XX

A LI EN TAX ATI ON INV OL VE D (Y /N) : X

**** *** *** *** *( LI NE 2 3 R ESE RVE D FO R AP P LI CAT ION S IN FORM ATI O N) *** ** ** **** *** ***
**** *** *** *** *( LI NE 2 4 R ESE RVE D FO R OP ER A TIN G S YS TE MS I NFO RM A TIO N) ** **** *** **
SCREEN FR
MSOM

This screen is used to record payment information. Direct deposit items are specifically
identified as bank account, direct express, check digit code, deposit payment code, and deposit
account number.

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