239 lines
11 KiB
HTML
239 lines
11 KiB
HTML
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<!doctype html>
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<html id="Tos001" lang="en">
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<head>
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<meta name="checkpointVersion" content="1.0.693, CDV=6.21" />
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<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
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<meta http-equiv="X-UA-Compatible" content="IE=7, IE=edge">
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<meta name="env" content="prd" />
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<meta http-equiv="Pragma" content="no-cache" />
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<meta http-equiv="expires" content="-1" />
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<meta http-equiv="expires" content="0" />
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<meta http-equiv="Cache-Control" content="no-store" />
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<meta http-equiv="Cache-Control" content="no-cache" />
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<meta http-equiv="Cache-Control" content="must-revalidate" />
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<meta http-equiv="Cache-Control" content="proxy-revalidate" />
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<meta http-equiv="Cache-Control" content="max-age=0" />
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<title>Apply for Benefits, Social Security</title>
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<style>
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@import url(https://www.socialsecurity.gov/flexweb/rel_4_6a/styles/import.css);
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</style>
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<style type="text/css">@import url(appstyles/app.css);</style>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/yahoo-dom-event.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/element-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/tabview-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/paginator-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/datatable-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/datasource-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/container-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/containerariaplugin-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/button-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/buttonariaplugin-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/cookie-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/menu-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/menuariaplugin-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/calendar-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/connection-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/selector-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/stylesheet-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/yahoo/json-min.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.namespace.js"></script>
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<script>SSA.deployment.setURL("https://www.socialsecurity.gov/flexweb/rel_4_6a/");</script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.fn.setup.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.localize.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.forms.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.forms.dynamic.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.forms.enhanced.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.forms.enterKey.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.page.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.page.links.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.page.print.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.page.tables.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.page.timeout.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.page.exit.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.uef.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.uef.navigation.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.uef.table.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.uef.container.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.uef.forms.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.fn.uef.calendar.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.fn.offhours.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.fn.accesskeys.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.fn.uef.bii.data.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.fn.uef.bii.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/javascript/ssa/ssa.fn.uef.lightbox.js"></script>
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<script src="https://www.socialsecurity.gov/flexweb/rel_4_6a/libs/wforms/wforms_pack.js"></script>
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<script type="text/javascript">if(SSA && SSA.fn && SSA.fn.setup){ SSA.fn.setup.config({ pageTimeout: { URL:"SessionTimeExtender"} }); }</script>
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<script type="text/javascript">
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/*<![CDATA[*/
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document.cookie = "IV_JCT=%2FiClaim; path=/;secure";
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/*]]>*/
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</script>
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</head>
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<body id="fw-app" class="fw-thmNeo">
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<div id="fw-container">
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<div id="fw-header" role="banner">
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<a id="fw-skipNav" href="#fw-content" accesskey="K">Skip to Content</a>
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<div id="fw-websiteIdentity">
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<div id="fw-logo">
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<a href="http://www.socialsecurity.gov/" target="_blank">
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<img src="https://www.socialsecurity.gov/flexweb/rel_4_6a/images/ssa-logo-52x38.png" alt="SSA Logo"/>
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</a>
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</div>
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<div id="fw-websiteTitle">
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<h1>Social Security</h1><p id="fw-tagline">
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The Official Website of the U.S. Social Security Administration
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</p>
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</div>
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</div>
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<div id="fw-global">
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<ul id="fw-globalOptions">
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<li id="fw-textsize" class="fw-first"><a rel="msg" target="_blank" href="http://www.socialsecurity.gov/webcontent/textsize.htm">Need Larger Text?</a></li><li id="fw-accessibility"><a rel="msg" target="_blank" href="http://www.socialsecurity.gov/accessibility/">Accessibility Help</a></li></ul>
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</div>
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</div>
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<noscript>
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<div id="fw-JavaScriptOff">
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<div class="yui3-g">
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<div class="yui3-u-3-4">
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<div class="content">
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<div class="uef-important uef-notice module">
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<div class="hd">
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<h4 tabindex="0">
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JavaScript is required to use this service
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</h4>
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</div>
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<div class="bd">
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<p>Social Security's online services are designed to be accessible and user-friendly. That is why we require all web browsers to have JavaScript enabled when working with our online services.</p>
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<p>To use this service, please adjust your web browser settings to enable JavaScript, then <a href="/iClaim/dib">try again</a>.</p>
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<p>If you can't or don't want to enable JavaScript, you can return to the <a href="http://www.socialsecurity.gov/">Social Security home page</a>.</p>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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</noscript>
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<div id="fw-main" class="hide">
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<script>
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var jsOffMsg = document.getElementById("fw-JavaScriptOff");
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if(jsOffMsg) {jsOffMsg.parentNode.removeChild(jsOffMsg);}
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var mainSection = document.getElementById("fw-main");
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if(mainSection) {YAHOO.util.Dom.removeClass(mainSection, "hide");}
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</script>
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<div id="fw-pageTitle" class="section">
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<h2>Apply for Benefits</h2>
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</div>
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<div id="fw-content" role="main">
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<form id="Tos001" name="Tos001" action="/iClaim/Tos001.action" method="post">
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<input type="hidden" name="struts.token.name" value="Tos001_iClaim_TOKEN" />
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<input type="hidden" name="Tos001_iClaim_TOKEN" value="D0KRJJVMLVGYBHSOY9UC6Z7WZPTOLP86" />
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<div class="yui3-g">
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<div class="yui3-u-3-4">
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<div class="content">
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<div class="uef-agreement uef-gradient uef-notice module">
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<div class="hd">
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<h3>
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Benefits Application Terms of Service
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</h3>
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</div>
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<div class="bd">
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<p>
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I understand that I am entering a U.S. Government System to file a benefit application with the Social Security Administration. I understand that I need to provide the Social Security Administration information to process the benefit application. I understand that failing to agree to the statements below will result in my inability to file a benefit application online, which may prevent the Social Security Administration from making an accurate and timely decision about eligibility for benefits.
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</p>
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<p>
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I understand that:
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</p>
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<ul>
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<li>the Social Security Administration will validate the information I provide against the information in Social Security Administration's systems.
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</li>
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<li>my activities may be monitored within this site.
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</li>
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<li>any person who knowingly and willfully tries to obtain Social Security benefits falsely could be punished by a fine or imprisonment, or both.
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</li>
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<li>I am authorized to file a claim on my own behalf or on behalf of someone else with the Social Security Administration.
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</li>
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</ul>
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</div>
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<div class="ft">
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<div class="uef-checkbox uef-input">
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<input type="checkbox" name="termSrvAgreeSw" id="termsrvagreesw" value="Y" aria-labelledby="termsrvagreeswLabel"/><label for="termsrvagreesw" id="termsrvagreeswLabel"> I understand and agree to the above statements.
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<span class="hide-offscreen">Details preceding</span></label>
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</div>
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</div>
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<div class="bd">
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<div><strong>Information about Social Security's Online Policies</strong></div>
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We are committed to protecting individual privacy and securing the personal information made available to us when you visit our website, SSA.gov. Our <a href="https://www.ssa.gov/agency/privacy.html" target="_blank" rel="noopener noreferrer"> Internet Privacy Policy</a> explains our online information practices.
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</div>
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</div>
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<div class="uef-formControls" id="bottom">
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<input type="submit" value="Next" name="BTN_NEXT"
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id="btn_next" class="uef-btn uef-btn-primary" accesskey="N"/>
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<input type="submit" value="Exit" name="BTN_EXIT"
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id="btn_exit" class="uef-btn uef-btn-secondary"/>
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</div>
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</div>
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</div>
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</div>
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</form>
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</div>
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</div>
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</div>
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</body>
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</html>
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