/* global React */ const { useState } = React; // ─────────── Draft Form Preview ─────────── const DraftPreview = ({ onDone, onBack }) => { return (
Draft · SSA-16 preview
Your SSDI Application
Print Download Continue to final review →
{/* DRAFT watermark */}
DRAFT
FORM SSA-16-BK
Application for Disability Insurance Benefits
OMB No. 0960-0618
Page 1 of 6
This is a draft preview only. Nothing has been submitted to the Social Security Administration. A human reviewer will check this before anything is filed.
Section 1 — Applicant Information
{[ ['Full name (last, first, middle)', 'Ramirez, Maria L.'], ['Social Security number', '•••-••-4719'], ['Date of birth', 'June 12, 1979'], ['Place of birth', 'Newark, NJ, USA'], ['Mailing address', '1248 Elm St, Apt 3B, Brooklyn, NY 11226'], ['Phone', '(347) 555-0132'], ].map(([k,v]) => (
{k}
{v}
))}
Section 2 — Medical Condition
Primary condition(s) preventing you from working
Applicant reports fibromyalgia with widespread pain, cognitive fog, and chronic fatigue. Onset of functional impairment documented as March 2023 following a workplace fall. Symptoms have persisted continuously for more than 12 months and are expected to last another 12+ months per treating physician (Dr. A. Patel, MD).
First treatment date
February 14, 2023
Most recent visit
November 22, 2024
Section 3 — Work History (last 15 years)
EmployerRoleFromTo
Riverside Medical CenterAdmin AssistantAug 2019Mar 2023
Bright Start DaycareAssistant TeacherJun 2014Jul 2019
Target Stores #2187CashierOct 2010May 2014
Continued on page 2 · generated by GovEase DCW · Not for submission
); }; // ─────────── Final Review & E-sign ─────────── const FinalReview = ({ onDone, onBack }) => { const { tweaks } = useApp(); const T = tweaks.lang === 'ES'; const [acks, setAcks] = useState({ a:false, b:false, c:false }); const [sig, setSig] = useState(''); const ready = Object.values(acks).every(Boolean) && sig.trim().length > 3; return (
{T?'Revisión final':'Final review & acknowledgment'}

{T?'Último paso antes de enviar.':'Last step before we file.'}

{T?'Léalo con calma. Una vez firmado, su reviewer enviará el paquete a la SSA dentro de 24 horas.':'Take your time. Once you sign, your reviewer submits the package to the SSA within 24 hours.'}

{/* Bilingual summary cards */}
{[ { en:'Applicant', es:'Solicitante', v:'Maria L. Ramirez · DOB Jun 12, 1979' }, { en:'Case type', es:'Tipo de caso', v:'Social Security Disability Insurance (SSDI)' }, { en:'Primary condition', es:'Condición principal', v:'Fibromyalgia · onset Mar 2023' }, { en:'Documents attached', es:'Documentos adjuntos', v:'8 files · 12.4 MB' }, { en:'Reviewer', es:'Revisor', v:'J. Delacruz · approved Apr 22' }, { en:'Filing target', es:'Fecha de envío', v:'Apr 24, 2026 · 9:00 AM ET' }, ].map((row, i) => (
{row.en} · {row.es}
{row.v}
))}

Your acknowledgment

Bilingual record
{[ { k:'a', en:'I confirm all information is true and complete to the best of my knowledge.', es:'Confirmo que toda la información es verdadera y completa a mi leal saber.' }, { k:'b', en:'I understand this is submitted to a federal agency and false statements are punishable by law.', es:'Entiendo que se envía a una agencia federal y las declaraciones falsas son punibles por ley.' }, { k:'c', en:'I authorize GovEase and the assigned reviewer to file this packet on my behalf.', es:'Autorizo a GovEase y al revisor asignado a presentar este paquete en mi nombre.' }, ].map(a => ( ))}
Digital signature
setSig(e.target.value)}/>
Signed by
{sig || '—'}
Date
Apr 23, 2026 · 3:47 PM ET
Go back to draft Sign & submit to SSA
); }; // ─────────── Secure Delivery ─────────── const DeliveryScreen = ({ onDone }) => { return (
Case GE-2026-4782 · submitted

Your packet is on its way.

Everything was filed with the SSA at Apr 24, 2026 · 9:02 AM ET. Confirmation emailed to maria.r@outlook.com.

Your full packet
SSDI_Maria_Ramirez.zip
Download
8 documents Link expires in 72h Password-protected
What happens next? The SSA typically takes 3–5 months to reach a decision. You'll get an SSA-acknowledgment letter in the mail within 14 days. Keep that letter — you'll need the case number on it for any follow-up.
Go to dashboard Refer a friend
); }; // ─────────── Retention / Delete Request ─────────── const RetentionScreen = ({ onBack }) => { const [confirm, setConfirm] = useState(false); return (
Data & privacy

Your data, your choice.

Here\'s what we hold, for how long, and how to get rid of it.

Retention policy

{[ { label:'Your intake answers', span:'24 months after submission', why:'Required by SSA audit rules.' }, { label:'Uploaded documents', span:'24 months after submission, then deleted', why:'Originals returned to you; copies erased.' }, { label:'Audit log & consent records', span:'7 years (legal requirement)', why:'Anonymized after case closure.' }, { label:'Account & contact info', span:'Until you delete your account', why:'Used only to log you back in.' }, ].map((r,i) => (
{r.label}
{r.why}
{r.span}
))}

Delete everything

Permanently erases your intake answers, uploaded documents, and personal details. Cannot be undone. Audit logs are retained per legal requirements (anonymized).

{!confirm ? ( setConfirm(true)}>Request deletion ) : (
Type DELETE to confirm:
setConfirm(false)}>Cancel Yes, delete my case
)}
); }; Object.assign(window, { DraftPreview, FinalReview, DeliveryScreen, RetentionScreen });