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Routine: EASEZP64

Package: Enrollment Application System

Routine: EASEZP64


Information

EASEZP64 ; ALB/AMA,LBD - Print 1010EZ, Version 6 or greater, Cont. ; 10/29/12 12:30pm

Source Information

Source file <EASEZP64.m>

Entry Points

Name Comments DBIA/ICR reference
EN(EALNE,EAINFO,EASDG)
NET ; Print SECTION IX - PREVIOUS CALENDAR YEAR NET WORTH
PAP ; Print SECTION X - PAPERWORK AND PRIVACY ACT INFORMATION
CON ; Print SECTION XI - CONSENT TO COPAYS
AOB ; Print SECTION XII - ASSIGNMENT OF BENEFITS

Interaction Calls

Name Line Occurrences
Function Call: WRITE
  • Prompt: !!?2,"SECTION IX - PREVIOUS CALENDAR YEAR NET WORTH (INCOME YEAR: ",@EASD@(999),") (Use a separate sheet for additional dependents)"
  • Line Location: NET+2
Function Call: WRITE
  • Prompt: !!?38,"SECTION IX - PREVIOUS CALENDAR YEAR NET WORTH (Use a separate sheet for additional dependents)"
  • Line Location: NET+3
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: NET+4
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: NET+4
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: NET+4
Function Call: WRITE
  • Prompt: !?78,"|",?84,"VETERAN",?96,"|",?102,"SPOUSE",?114,"|",?120,"CHILD 1"
  • Line Location: NET+6
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: NET+7
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: NET+7
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: NET+7
Function Call: WRITE
  • Prompt: !,"1. CASH, AMOUNT IN BANK ACCOUNTS (e.g., checking and savings accounts,",?78,"| $ ",$P(@EASD@("2E1"),U),?96,"| $ ",$P(@EASD@("2E1"),U,2),?114,"| $ ",$P(@EASD@("2E1"),U,3)
  • Line Location: NET+9
Function Call: WRITE
  • Prompt: !,"certificates of deposit, individual retirement accounts, stocks and bonds)",?78,"|",?96,"|",?114,"|"
  • Line Location: NET+10
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: NET+11
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: NET+11
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: NET+11
Function Call: WRITE
  • Prompt: !,"2. MARKET VALUE OF LAND AND BUILDINGS MINUS MORTGAGES AND LIENS (e.g., second",?78,"| $ ",$P(@EASD@("2E2"),U),?96,"| $ ",$P(@EASD@("2E2"),U,2),?114,"| $ ",$P(@EASD@("2E2"),U,3)
  • Line Location: NET+13
Function Call: WRITE
  • Prompt: !,"homes and non-income-producing property. Do not count your primary home.)",?78,"|",?96,"|",?114,"|"
  • Line Location: NET+14
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: NET+15
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: NET+15
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: NET+15
Function Call: WRITE
  • Prompt: !,"3. VALUE OF OTHER PROPERTY OR ASSETS (e.g., art, rare coins, collectibles)",?78,"| $ ",$P(@EASD@("2E3"),U),?96,"| $ ",$P(@EASD@("2E3"),U,2),?114,"| $ ",$P(@EASD@("2E3"),U,3)
  • Line Location: NET+17
Function Call: WRITE
  • Prompt: !,"MINUS THE AMOUNT YOU OWE ON THESE ITEMS. INCLUDE VALUE OF FARM, RANCH, OR",?78,"|",?96,"|",?114,"|"
  • Line Location: NET+18
Function Call: WRITE
  • Prompt: !,"BUSINESS ASSETS. Exclude household effects and family vehicles.",?78,"|",?96,"|",?114,"|"
  • Line Location: NET+19
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: NET+20
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: NET+20
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: NET+20
Function Call: WRITE
  • Prompt: !!?34,"SECTION X - PAPERWORK REDUCTION ACT AND PRIVACY ACT INFORMATION"
  • Line Location: PAP+2
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: PAP+3
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: PAP+3
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: PAP+3
Function Call: WRITE
  • Prompt: !,"The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the"
  • Line Location: PAP+5
Function Call: WRITE
  • Prompt: !,"clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not"
  • Line Location: PAP+6
Function Call: WRITE
  • Prompt: !,"required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by"
  • Line Location: PAP+7
Function Call: WRITE
  • Prompt: !,"all individuals who must complete this form will average 45 minutes. This includes the time it will take to read instructions,"
  • Line Location: PAP+8
Function Call: WRITE
  • Prompt: !,"gather the necessary facts and fill out the form."
  • Line Location: PAP+9
Function Call: WRITE
  • Prompt: !,"Privacy Act Information: VA is asking you to provide the information on this form under 38 U.S.C., sections 1705, 1710, 1712,"
  • Line Location: PAP+10
Function Call: WRITE
  • Prompt: !,"and 1722 in order for VA to determine your eligibility for medical benefits. Information you supply may be verified through a"
  • Line Location: PAP+11
Function Call: WRITE
  • Prompt: !,"computer-matching program. VA may disclose the information that you put on the form as permitted by law. VA may make a ""routine"
  • Line Location: PAP+12
Function Call: WRITE
  • Prompt: !,"use"" disclosure of the information as outlined in the Privacy Act systems of records notices and in accordance with the VHA Notice"
  • Line Location: PAP+13
Function Call: WRITE
  • Prompt: !,"of Privacy Practices. Providing the requested information is voluntary, but if any or all of the requested information is not"
  • Line Location: PAP+14
Function Call: WRITE
  • Prompt: !,"provided, it may delay or result in denial of your request for health care benefits. Failure to furnish the information will not"
  • Line Location: PAP+15
Function Call: WRITE
  • Prompt: !,"have any effect on any other benefits to which you may be entitled. If you provide VA your Social Security Number, VA will use it"
  • Line Location: PAP+16
Function Call: WRITE
  • Prompt: !,"to administer your VA benefits. VA may also use this information to identify Veterans and persons claiming or receiving VA"
  • Line Location: PAP+17
Function Call: WRITE
  • Prompt: !,"benefits and their records, and for other purposes authorized or required by law."
  • Line Location: PAP+18
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: PAP+19
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: PAP+19
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: PAP+19
Function Call: WRITE
  • Prompt: !!?49,"SECTION XI - CONSENT TO COPAYS"
  • Line Location: CON+2
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: CON+3
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: CON+3
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: CON+3
Function Call: WRITE
  • Prompt: !,"By signing this application you are agreeing to pay the applicable VA copays for treatment or services of your NSC conditions as"
  • Line Location: CON+5
Function Call: WRITE
  • Prompt: !,"required by law."
  • Line Location: CON+6
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: CON+7
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: CON+7
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: CON+7
Function Call: WRITE
  • Prompt: !!?48,"SECTION XII - ASSIGNMENT OF BENEFITS"
  • Line Location: AOB+2
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: AOB+3
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: AOB+3
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: AOB+3
Function Call: WRITE
  • Prompt: !,"I understand that pursuant to 38 U.S.C. section 1729 and 42 U.S.C. 2651, the Department of Veterans Affairs (VA) is authorized to"
  • Line Location: AOB+5
Function Call: WRITE
  • Prompt: !,"recover or collect from my health plan (HP) or any other legally responsible third party for the reasonable charges of "
  • Line Location: AOB+6
Function Call: WRITE
  • Prompt: !,"nonservice-connected VA medical care or services furnished or provided to me. I hereby authorize payment directly to VA from any"
  • Line Location: AOB+7
Function Call: WRITE
  • Prompt: !,"HP under which I am covered (including coverage provided under my spouse's HP) that is responsible for payment of the charges for"
  • Line Location: AOB+8
Function Call: WRITE
  • Prompt: !,"my medical care, including benefits otherwise payable to me or my spouse. Furthermore, I hereby assign to the VA any claim I may"
  • Line Location: AOB+9
Function Call: WRITE
  • Prompt: !,"have against any person or entity who is or may be legally responsible for the payment of the cost of medical services provided to"
  • Line Location: AOB+10
Function Call: WRITE
  • Prompt: !,"me by the VA. I understand that this assignment shall not limit or prejudice my right to recover for my own benefit any amount in"
  • Line Location: AOB+11
Function Call: WRITE
  • Prompt: !,"excess of the cost of medical services provided to me by the VA or any other amount to which I may be entitled. I hereby appoint"
  • Line Location: AOB+12
Function Call: WRITE
  • Prompt: !,"the Attorney General of the United States and the Secretary of Veterans' Affairs and their designees as my Attorneys-in-fact to"
  • Line Location: AOB+13
Function Call: WRITE
  • Prompt: !,"take all necessary and appropriate actions in order to recover and receive all or part of the amount herein assigned. I hereby"
  • Line Location: AOB+14
Function Call: WRITE
  • Prompt: !,"authorize the VA to disclose, to my attorney and to any third party or administrative agency who may be responsible for payment of"
  • Line Location: AOB+15
Function Call: WRITE
  • Prompt: !,"the cost of medical services provided to me, information from my medical records as necessary to verify my claim. Further, I hereby"
  • Line Location: AOB+16
Function Call: WRITE
  • Prompt: !,"authorize any such third party or administrative agency to disclose to the VA any information regarding my claim."
  • Line Location: AOB+17
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: AOB+18
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: AOB+18
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: AOB+18
Function Call: WRITE
  • Prompt: !!?6,"ALL APPLICANTS MUST SIGN AND DATE THIS FORM. REFER TO INSTRUCTIONS WHICH DEFINE WHO CAN SIGN ON BEHALF OF THE VETERAN.",!
  • Line Location: AOB+20
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: AOB+21
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: AOB+21
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: AOB+21
Function Call: WRITE
  • Prompt: !,"SIGNATURE OF APPLICANT",?90,"| DATE"
  • Line Location: AOB+23
Function Call: WRITE
  • Prompt: !,"SIGNATURE OF APPLICANT OR APPLICANT'S REPRESENTATIVE HAS BEEN VERIFIED",?90,"| ",EASIGN,!?90,"|"
  • Line Location: AOB+24
Function Call: WRITE
  • Prompt: !?90,"|",!?90,"|"
  • Line Location: AOB+25
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: AOB+26
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: AOB+26
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: AOB+26

FileMan Files Accessed Via FileMan Db Call

FileNo Call Tags
^EAS(712 - [#712] GET1^DIQ
Info |  Source |  Entry Points |  Interaction Calls |  FileMan Files Accessed Via FileMan Db Call