Class: PdfFill::Forms::Va686c674
- Includes:
- FormHelper
- Defined in:
- lib/pdf_fill/forms/va686c674.rb
Constant Summary collapse
- ITERATOR =
PdfFill::HashConverter::ITERATOR
- KEY =
{ 'veteran_information' => { 'full_name' => { 'first' => { key: 'form1[0].#subform[17].VeteranFirstName[0]', limit: 12, question_num: 1, question_suffix: 'A', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VETERAN\'S NAME' }, 'middleInitial' => { key: 'form1[0].#subform[17].VeteranMiddleInitial1[0]', limit: 1, question_num: 1, question_suffix: 'B', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VETERAN\'S NAME' }, 'last' => { key: 'form1[0].#subform[17].VeteranLastName[0]', limit: 18, question_num: 1, question_suffix: 'C', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VETERAN\'S NAME' } # suffix }, 'ssn' => { 'first' => { key: 'form1[0].#subform[17].Veterans_SocialSecurityNumber_FirstThreeNumbers[0]', limit: 3, question_num: 4, question_suffix: 'A', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VETERAN\'S SOCIAL SECURITY NUMBER' }, 'second' => { key: 'form1[0].#subform[17].Veterans_SocialSecurityNumber_SecondTwoNumbers[0]', limit: 2, question_num: 4, question_suffix: 'B', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VETERAN\'S SOCIAL SECURITY NUMBER' }, 'third' => { key: 'form1[0].#subform[17].Veterans_SocialSecurityNumber_LastFourNumbers[0]', limit: 4, question_num: 4, question_suffix: 'C', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VETERAN\'S SOCIAL SECURITY NUMBER' } }, 'va_file_number' => { key: 'form1[0].#subform[17].VAFileNumber[0]', limit: 9, question_num: 3, question_suffix: 'A', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VA FILE NUMBER (If known)' }, 'birth_date' => { 'month' => { key: 'form1[0].#subform[17].DOBmonth[0]', limit: 2, question_num: 4, question_suffix: 'A', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VETERAN\'S DATE OF BIRTH (MM-DD-YYYY)' }, 'day' => { key: 'form1[0].#subform[17].DOBday[0]', limit: 2, question_num: 4, question_suffix: 'B', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VETERAN\'S DATE OF BIRTH (MM-DD-YYYY)' }, 'year' => { key: 'form1[0].#subform[17].DOByear[0]', limit: 4, question_num: 4, question_suffix: 'C', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VETERAN\'S DATE OF BIRTH (MM-DD-YYYY)' } }, # claimant's name # claimant's social security number 'service_number' => { key: 'form1[0].#subform[17].VeteransServiceNumber[0]', limit: 9, question_num: 7, question_suffix: 'A', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > VETERAN\'S SERVICE NUMBER (If applicable)' } }, # end veteran_information 'dependents_application' => { 'veteran_contact_information' => { 'phone_number' => { 'phone_area_code' => { key: 'form1[0].#subform[17].TelephoneNumber_AreaCode[0]', limit: 3, question_num: 8, question_suffix: 'A', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > TELEPHONE NUMBER' }, 'phone_first_three_numbers' => { key: 'form1[0].#subform[17].TelephoneNumber_FirstThreeNumbers[0]', limit: 3, question_num: 8, question_suffix: 'B', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > TELEPHONE NUMBER' }, 'phone_last_four_numbers' => { key: 'form1[0].#subform[17].TelephoneNumber_LastFourNumbers[0]', limit: 4, question_num: 8, question_suffix: 'C', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > TELEPHONE NUMBER' } }, 'email_address' => { key: 'form1[0].#subform[17].Email_Address[0]', limit: 30, question_num: 9, question_suffix: 'A', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > E-MAIL ADDRESS' }, 'veteran_address' => { 'address_line1' => { key: 'form1[0].#subform[17].CurrentMailingAddress_NumberAndStreet[0]', limit: 30, question_num: 10, question_suffix: 'A', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > MAILING ADDRESS OF VETERAN/CLAIMANT' }, 'address_line2' => { key: 'form1[0].#subform[17].CurrentMailingAddress_ApartmentOrUnitNumber[0]', limit: 5, question_num: 10, question_suffix: 'B', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > MAILING ADDRESS OF VETERAN/CLAIMANT' }, # address_line3 'city' => { key: 'form1[0].#subform[17].CurrentMailingAddress_City[0]', limit: 18, question_num: 10, question_suffix: 'C', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > MAILING ADDRESS OF VETERAN/CLAIMANT' }, 'state_code' => { key: 'form1[0].#subform[17].CurrentMailingAddress_StateOrProvince[0]', limit: 2, question_num: 10, question_suffix: 'D', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > MAILING ADDRESS OF VETERAN/CLAIMANT' }, 'country_name' => { key: 'form1[0].#subform[17].CurrentMailingAddress_Country[0]', limit: 2, question_num: 10, question_suffix: 'E', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > MAILING ADDRESS OF VETERAN/CLAIMANT' }, 'zip_code' => { 'firstFive' => { key: 'form1[0].#subform[17].CurrentMailingAddress_ZIPOrPostalCode_FirstFiveNumbers[0]', limit: 5, question_num: 10, question_suffix: 'F', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > MAILING ADDRESS OF VETERAN/CLAIMANT' }, 'lastFour' => { key: 'form1[0].#subform[17].CurrentMailingAddress_ZIPOrPostalCode_LastFourNumbers[0]', limit: 4, question_num: 10, question_suffix: 'G', question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > MAILING ADDRESS OF VETERAN/CLAIMANT' } } } }, # end veteran_contact_information # ------------ SECTION II: INFORMATION NEEDED TO ADD SPOUSE ------------ # 'spouse_information' => { 'full_name' => { 'first' => { key: 'form1[0].#subform[17].SPOUSEFirstName[0]', limit: 12, question_num: 11, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE\'S NAME' }, 'middleInitial' => { key: 'form1[0].#subform[17].SPOUSEMiddleInitial1[0]', limit: 1, question_num: 11, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE\'S NAME' }, 'last' => { key: 'form1[0].#subform[17].SPOUSELastName[0]', limit: 18, question_num: 11, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE\'S NAME' } # suffix }, # end full_name 'birth_date' => { 'month' => { key: 'form1[0].#subform[17].DOBmonth[1]', limit: 2, question_num: 11, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE\'S DOB MONTH' }, 'day' => { key: 'form1[0].#subform[17].DOBday[1]', limit: 2, question_num: 11, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE\'S DOB DAY' }, 'year' => { key: 'form1[0].#subform[17].DOByear[1]', limit: 4, question_num: 11, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE\'S DOB YEAR' } }, # end birth_date 'ssn' => { 'first' => { key: 'form1[0].#subform[17].SpouseSocialSecurityNumber_FirstThreeNumbers[0]', limit: 3, question_num: 11, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE\'S SSN FIRST THREE NUMBERS' }, 'second' => { key: 'form1[0].#subform[17].SpouseSocialSecurityNumber_SecondTwoNumbers[0]', limit: 2, question_num: 11, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE\'S SSN SECOND TWO NUMBERS' }, 'third' => { key: 'form1[0].#subform[17].SpouseSocialSecurityNumber_LastFourNumbers[0]', limit: 4, question_num: 11, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE\'S SSN LAST FOUR NUMBERS' } }, # end spouse ssn 'is_veteran' => { 'is_veteran_yes' => { key: 'form1[0].#subform[17].YES[0]' }, 'is_veteran_no' => { key: 'form1[0].#subform[17].NO[0]' } }, 'va_file_number' => { # XXX this group needs three parts like SSN, name looks v. sim 'va_file_number_first_three' => { key: 'form1[0].#subform[17].SpouseSocialSecurityNumber_FirstThreeNumbers[1]', limit: 3, question_num: 12, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE VA FILE NUMBER > FIRST THREE' }, 'va_file_number_second_two' => { key: 'form1[0].#subform[17].SpouseSocialSecurityNumber_SecondTwoNumbers[1]', limit: 2, question_num: 12, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE VA FILE NUMBER > SECOND TWO' }, 'va_file_number_last_four' => { key: 'form1[0].#subform[17].SpouseSocialSecurityNumber_LastFourNumbers[1]', limit: 4, question_num: 12, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > SPOUSE VA FILE NUMBER > LAST FOUR' } }, # end of spouse va file number 'service_number' => { key: 'form1[0].#subform[17].SPOUSEServiceNumber[0]', limit: 9, question_num: 12, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > IS YOUR SPOUSE A VETERAN' } # end of spouse service number }, # end spouse_information 'current_marriage_information' => { 'date' => { 'month' => { key: 'form1[0].#subform[17].DOMARRIAGEmonth[0]', limit: 2, question_num: 11, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > DATE OF MARRIAGE MONTH' }, 'day' => { key: 'form1[0].#subform[17].DOMARRIAGEday[0]', limit: 2, question_num: 11, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > DATE OF MARRIAGE DAY' }, 'year' => { key: 'form1[0].#subform[17].DOMARRIAGEyear[0]', limit: 4, question_num: 11, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > DATE OF MARRIAGE YEAR' } }, 'location' => { 'city' => { key: 'form1[0].#subform[17].CurrentMailingAddress_City[2]', limit: 18, question_num: 11, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > MARRIAGE CITY' }, 'state' => { key: 'form1[0].#subform[17].CurrentMailingAddress_StateOrProvince[2]', limit: 2, question_num: 11, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > MARRIAGE STATE' }, 'country' => { key: 'form1[0].#subform[17].CurrentMailingAddress_Country[2]', limit: 2, question_num: 11, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > MARRIAGE COUNTRY' } }, # end location 'type' => { 'religious_ceremony' => { key: 'form1[0].#subform[17].ReligiousCeremony[0]' }, 'common_law' => { key: 'form1[0].#subform[17].CommonLaw[0]' }, 'tribal' => { key: 'form1[0].#subform[17].Tribal[0]' }, 'proxy' => { key: 'form1[0].#subform[17].Proxy[0]' }, 'other' => { key: 'form1[0].#subform[17].OTHER_Explain[0]' } }, # end of marriage type 'type_other' => { key: 'form1[0].#subform[17].Other[0]', limit: 9, question_num: 11, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > MARRIAGE TYPE OTHER EXPLANATION' } }, # end current_marriage_information 'does_live_with_spouse' => { 'spouse_does_live_with_veteran' => { 'spouse_does_live_with_veteran_yes' => { key: 'form1[0].#subform[17].YES[1]' }, 'spouse_does_live_with_veteran_no' => { key: 'form1[0].#subform[17].NO[1]' } }, 'current_spouse_reason_for_separation' => { key: 'form1[0].#subform[17].Reasonforseparation[0]', limit: 20, question_num: 13, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > REASON FOR SEPARATION' }, 'address' => { 'address_line1' => { key: 'form1[0].#subform[17].CurrentMailingAddress_NumberAndStreet[1]', limit: 30, question_num: 13, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > LIVING WITH SPOUSE > ADDRESS' }, 'address_line2' => { key: 'form1[0].#subform[17].CurrentMailingAddress_ApartmentOrUnitNumber[1]', limit: 5, question_num: 13, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > LIVING WITH SPOUSE > ADDRESS' }, 'city' => { key: 'form1[0].#subform[17].CurrentMailingAddress_City[1]', limit: 18, question_num: 13, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > LIVING WITH SPOUSE > CITY' }, 'state_code' => { key: 'form1[0].#subform[17].CurrentMailingAddress_StateOrProvince[1]', limit: 2, question_num: 13, question_suffix: 'D', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > LIVING WITH SPOUSE > STATE' }, 'country_name' => { key: 'form1[0].#subform[17].CurrentMailingAddress_Country[1]', limit: 2, question_num: 13, question_suffix: 'E', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > LIVING WITH SPOUSE > COUNTRY' }, 'zip_code' => { 'firstFive' => { key: 'form1[0].#subform[17].CurrentMailingAddress_ZIPOrPostalCode_FirstFiveNumbers[1]', limit: 5, question_num: 13, question_suffix: 'F', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > LIVING WITH SPOUSE > ZIP FIRST 5' }, # end of zip first 5 'lastFour' => { key: 'form1[0].#subform[17].CurrentMailingAddress_ZIPOrPostalCode_LastFourNumbers[1]', limit: 4, question_num: 13, question_suffix: 'G', question_text: 'INFORMATION NEEDED TO ADD SPOUSE > LIVING WITH SPOUSE > ZIP LAST 4' } # end of zip last 4 } # end of zip } # end of address }, # end does_live_with_spouse 'veteran_marriage_history' => { limit: 4, first_key: 'full_name', 'full_name' => { 'first' => { key: 'veteran.previousSpouse.firstName[%iterator%]', limit: 12, question_num: 14, question_suffix: 'A', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE FIRST NAME' }, 'middleInitial' => { key: 'form1[0].#subform[18].CHILDMiddleInitial1[%iterator%]', limit: 1, question_num: 14, question_suffix: 'B', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MIDDLE INITIAL' }, 'last' => { key: 'form1[0].#subform[18].CHILDLastName[%iterator%]', limit: 18, question_num: 14, question_suffix: 'C', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE LAST NAME' } # @TODO 'suffix' => FE has suffix but no place for it on PDF }, # end of end of full name 'start_date' => { 'month' => { key: 'veteran_marriage_history.start_date.month[%iterator%]', limit: 2, question_num: 14, question_suffix: 'E', question_text: 'PREVIOUS MARRIAGE HISTORY > MONTH' }, 'day' => { key: 'veteran_marriage_history.start_date.day[%iterator%]', limit: 2, question_num: 14, question_suffix: 'F', question_text: 'PREVIOUS MARRIAGE HISTORY > MONTH' }, 'year' => { key: 'veteran_marriage_history.start_date.year[%iterator%]', limit: 4, question_num: 14, question_suffix: 'G', question_text: 'PREVIOUS MARRIAGE HISTORY > YEAR' } }, # end of start_date 'start_location' => { 'city' => { key: 'veteran.previousMarriage.startCity[%iterator%]', limit: 18, question_num: 14, question_suffix: 'H', question_text: 'PREVIOUS MARRIAGE HISTORY > CITY' }, 'state' => { key: 'veteran_marriage_history.start_location.state[%iterator%]', limit: 2, question_num: 14, question_suffix: 'I', question_text: 'PREVIOUS MARRIAGE HISTORY > STATE' }, 'country' => { key: 'veteran_marriage_history.start_location.country[%iterator%]', limit: 2, question_num: 14, question_suffix: 'J', question_text: 'PREVIOUS MARRIAGE HISTORY > COUNTRY' } }, # end of start_location 'reason_marriage_ended' => { 'death' => { key: 'veteran_marriage_history.reason_marriage_ended.death[%iterator%]' }, 'divorce' => { key: 'veteran_marriage_history.reason_marriage_ended.divorce[%iterator%]' }, 'annulment' => { key: 'veteran_marriage_history.reason_marriage_ended.annulment[%iterator%]' }, 'other' => { key: 'veteran_marriage_history.reason_marriage_ended.other[%iterator%]' } }, 'reason_marriage_ended_other' => { key: 'veteran_marriage_history.reason_marriage_ended_other[%iterator%]', question_num: 14, question_suffix: 'K', question_text: 'PREVIOUS MARRIAGE HISTORY > REASON FOR TERMINATION' }, 'end_date' => { 'month' => { key: 'veteran_marriage_history.end_date.month[%iterator%]', limit: 2, question_num: 14, question_suffix: 'L', question_text: 'PREVIOUS MARRIAGE HISTORY > TERMINATION MONTH' }, 'day' => { key: 'veteran_marriage_history.end_date.day[%iterator%]', limit: 2, question_num: 14, question_suffix: 'M', question_text: 'PREVIOUS MARRIAGE HISTORY > TERMINATION DAY' }, 'year' => { key: 'veteran_marriage_history.end_date.year[%iterator%]', limit: 4, question_num: 14, question_suffix: 'N', question_text: 'PREVIOUS MARRIAGE HISTORY > TERMINATION YEAR' } }, # end of end date 'end_location' => { 'city' => { key: 'veteran.previousMarriage.terminationCity[%iterator%]', limit: 18, question_num: 14, question_suffix: 'O', question_text: 'PREVIOUS MARRIAGE HISTORY > TERMINATION CITY' }, 'state' => { key: 'veteran.previousMarriage.terminationState[%iterator%]', limit: 2, question_num: 14, question_suffix: 'P', question_text: 'PREVIOUS MARRIAGE HISTORY > TERMINATION STATE' }, 'country' => { key: 'veteran.previousMarriage.terminationCountry[%iterator%]', limit: 2, question_num: 14, question_suffix: 'Q', question_text: 'PREVIOUS MARRIAGE HISTORY > TERMINATION COUNTRY' } } # end end_location }, # end veteran_marriage_history 'spouse_marriage_history' => { limit: 4, first_key: 'full_name', 'full_name' => { 'first' => { key: 'veteranSpouse.previousSpouse.firstName[%iterator%]', limit: 12, question_num: 15, question_suffix: 'A', question_text: 'PREVIOUS MARRIAGE HISTORY > SPOUSES PREVIOUS SPOUSE FIRST NAME' }, 'middleInitial' => { key: 'veteranSpouse.previousSpouse.middleInitial[%iterator%]', limit: 1, question_num: 15, question_suffix: 'B', question_text: 'PREVIOUS MARRIAGE HISTORY > SPOUSES PREVIOUS SPOUSE MIDDLE INITIAL' }, 'last' => { key: 'veteranSpouse.previousSpouse.lastName[%iterator%]', limit: 18, question_num: 15, question_suffix: 'C', question_text: 'PREVIOUS MARRIAGE HISTORY > SPOUSES PREVIOUS SPOUSE LAST NAME' } # @TODO 'suffix' => FE has suffix but no place for it on PDF }, # end of full name 'start_date' => { 'month' => { key: 'spouse_marriage_history.start_date.month[%iterator%]', limit: 2, question_num: 15, question_suffix: 'A', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE DATE MONTH' }, 'day' => { key: 'spouse_marriage_history.start_date.day[%iterator%]', limit: 2, question_num: 15, question_suffix: 'B', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE DATE DAY' }, 'year' => { key: 'spouse_marriage_history.start_date.year[%iterator%]', limit: 4, question_num: 15, question_suffix: 'C', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE DATE YEAR' } }, # end of start date 'start_location' => { 'city' => { key: 'spouse_marriage_history.start_location.city[%iterator%]', limit: 18, question_num: 15, question_suffix: 'D', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE LOCATION CITY' }, 'state' => { key: 'spouse_marriage_history.start_location.state[%iterator%]', limit: 2, question_num: 15, question_suffix: 'E', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE LOCATION STATE' }, 'country' => { key: 'spouse_marriage_history.start_location.country[%iterator%]', limit: 2, question_num: 15, question_suffix: 'F', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE LOCATION COUNTRY' } }, # end start_location 'reason_marriage_ended' => { 'death' => { key: 'spouse_marriage_history.reason_marriage_ended.death[%iterator%]' }, 'divorce' => { key: 'spouse_marriage_history.reason_marriage_ended.divorce[%iterator%]' }, 'annulment' => { key: 'spouse_marriage_history.reason_marriage_ended.annulment[%iterator%]' }, 'other' => { key: 'spouse_marriage_history.reason_marriage_ended.other[%iterator%]' } }, 'reason_marriage_ended_other' => { key: 'spouse_marriage_history.reason_marriage_ended_other[%iterator%]', question_num: 15, question_suffix: 'G', question_text: 'PREVIOUS MARRIAGE HISTORY > REASON FOR TERMINATION' }, 'end_date' => { 'month' => { key: 'spouse_marriage_history.end_date.month[%iterator%]', limit: 2, question_num: 15, question_suffix: 'H', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE DATE ENDED MONTH' }, # end of end date month 'day' => { key: 'spouse_marriage_history.end_date.day[%iterator%]', limit: 2, question_num: 15, question_suffix: 'I', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE DATE ENDED DAY' }, # end of end date day 'year' => { key: 'spouse_marriage_history.end_date.year[%iterator%]', limit: 4, question_num: 15, question_suffix: 'J', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE DATE ENDED YEAR' } # end of end date year }, # end of end date 'end_location' => { 'city' => { key: 'spouse_marriage_history.end_location.city[%iterator%]', limit: 18, question_num: 15, question_suffix: 'K', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE TERMINATION CITY' }, 'state' => { key: 'spouse_marriage_history.end_location.state[%iterator%]', limit: 2, question_num: 15, question_suffix: 'L', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE TERMINATION STATE' }, 'country' => { key: 'spouse_marriage_history.end_location.country[%iterator%]', limit: 2, question_num: 15, question_suffix: 'M', question_text: 'PREVIOUS MARRIAGE HISTORY > PREVIOUS SPOUSE MARRIAGE TERMINATION COUNTRY' } } # end location }, # end spouse_marriage_history # ----------------- SECTION III: INFORMATION NEEDED TO ADD CHILD(REN) ----------------- # 'children_to_add' => { limit: 6, first_key: 'full_name', 'full_name' => { 'first' => { key: 'children_to_add.full_name.first[%iterator%]', limit: 12, question_num: 16, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > FIRST NAME' }, 'middleInitial' => { key: 'children_to_add.full_name.middleInitial[%iterator%]', limit: 1, question_num: 16, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > MIDDLE INITIAL' }, 'last' => { key: 'children_to_add.full_name.last[%iterator%]', limit: 18, question_num: 16, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > LAST NAME' } # @TODO 'suffix' => FE has suffix but no place for it on PDF }, # end of full name 'ssn' => { 'first' => { key: 'children_to_add.ssn.first[%iterator%]', limit: 3, question_num: 16, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > FIRST THREE SSN' }, # end of ssn first three 'second' => { key: 'children_to_add.ssn.second[%iterator%]', limit: 2, question_num: 16, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > SECOND TWO SSN' }, # end of second two 'third' => { key: 'children_to_add.ssn.third[%iterator%]', limit: 4, question_num: 16, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > LAST FOUR SSN' } # end of last four }, # end of ssn 'birth_date' => { 'month' => { key: 'children_to_add.birth_date.month[%iterator%]', limit: 2, question_num: 16, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > THEIR BIRTHDAY MONTH' }, 'day' => { key: 'children_to_add.birth_date.day[%iterator%]', limit: 4, question_num: 16, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > THEIR BIRTHDAY DAY' }, 'year' => { key: 'children_to_add.birth_date.year[%iterator%]', limit: 4, question_num: 16, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > THEIR BIRTHDAY YEAR' } }, # birth_date 'place_of_birth' => { 'city' => { key: 'children_to_add.place_of_birth.city[%iterator%]', limit: 18, question_num: 16, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > PLACE OF BIRTH > CITY' }, 'state' => { key: 'children_to_add.place_of_birth.state[%iterator%]', limit: 2, question_num: 16, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > PLACE OF BIRTH > STATE' }, 'country' => { key: 'children_to_add.place_of_birth.country[%iterator%]', limit: 2, question_num: 16, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > PLACE OF BIRTH > COUNTRY' } }, # end place_of_birth 'child_address_info' => { 'person_child_lives_with' => { 'first' => { key: 'children_to_add.child_address_info.person_child_lives_with.first[%iterator%]', limit: 12, question_num: 16, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > CHILD DOES NOT LIVE WITH CLAIMANT > FIRST NAME' }, # end of first name 'middleInitial' => { key: 'children_to_add.child_address_info.person_child_lives_with.middleInitial[%iterator%]', limit: 1, question_num: 16, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > CHILD DOES NOT LIVE WITH CLAIMANT > MIDDLE' }, # end of middle initial 'last' => { key: 'children_to_add.child_address_info.person_child_lives_with.last[%iterator%]', limit: 18, question_num: 16, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > CHILD DOES NOT LIVE WITH CLAIMANT > LAST NAME' } # end of last name }, # end of person child lives with 'address' => { 'address_line1' => { key: 'children_to_add.child_address_info.address.address_line1[%iterator%]', limit: 27, question_num: 16, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > CHILD DOES NOT LIVE WITH CLAIMANT > ADDRESS' }, # end of address line1 'address_line2' => { key: 'children_to_add.child_address_info.address.address_line2[%iterator%]', limit: 5, question_num: 16, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > CHILD DOES NOT LIVE WITH CLAIMANT > ADDRESS' }, 'city' => { key: 'children_to_add.child_address_info.address.city[%iterator%]', limit: 18, question_num: 16, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > CHILD DOES NOT LIVE WITH CLAIMANT > CITY' }, # end of city 'state_code' => { key: 'children_to_add.child_address_info.address.state_code[%iterator%]', limit: 2, question_num: 16, question_suffix: 'D', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > CHILD DOES NOT LIVE WITH CLAIMANT > STATE' }, 'country_name' => { key: 'children_to_add.child_address_info.address.country_name[%iterator%]', limit: 2, question_num: 16, question_suffix: 'E', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > CHILD DOES NOT LIVE WITH CLAIMANT > COUNTRY' }, 'zip_code' => { 'firstFive' => { key: 'children_to_add.child_address_info.address.zip_code.first_five[%iterator%]', limit: 5, question_num: 16, question_suffix: 'F', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > CHILD DOES NOT LIVE WITH CLAIMANT > ZIP' }, 'lastFour' => { key: 'children_to_add.child_address_info.address.zip_code.last_four[%iterator%]', limit: 4, question_num: 16, question_suffix: 'G', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > CHILD DOES NOT LIVE WITH CLAIMANT > ZIP' } } } # end address }, # end child_address_info 'child_status' => { 'biological' => { key: 'children_to_add.child_status.biological[%iterator%]' }, 'school_age_in_school' => { key: 'children_to_add.child_status.school_age_in_school[%iterator%]' }, 'adopted' => { key: 'children_to_add.child_status.adopted[%iterator%]' }, 'incapable_self_support' => { key: 'children_to_add.child_status.incapable_self_support[%iterator%]' }, 'child_previously_married' => { key: 'children_to_add.child_status.child_previously_married[%iterator%]' }, 'stepchild' => { key: 'children_to_add.child_status.stepchild[%iterator%]' }, 'date_became_dependent' => { 'month' => { key: 'children_to_add.child_status.date_became_dependent.month[%iterator%]' }, 'day' => { key: 'children_to_add.child_status.date_became_dependent.day[%iterator%]' }, 'year' => { key: 'children_to_add.child_status.date_became_dependent.year[%iterator%]' } }, 'biological_stepchild_0' => { # there can only be up to 6 stepchildren filled out including the addendum. 'biological_stepchild_0_true' => { key: 'form1[0].#subform[21].#subform[22].RadioButtonList[41]' }, 'biological_stepchild_0_false' => { key: 'form1[0].#subform[21].#subform[22].RadioButtonList[42]' } }, 'biological_stepchild_1' => { 'biological_stepchild_1_true' => { key: 'form1[0].#subform[21].#subform[22].RadioButtonList[52]' }, 'biological_stepchild_1_false' => { key: 'form1[0].#subform[21].#subform[22].RadioButtonList[53]' } }, 'biological_stepchild_2' => { 'biological_stepchild_2_true' => { key: 'form1[0].#subform[23].#subform[24].RadioButtonList[74]' }, 'biological_stepchild_2_false' => { key: 'form1[0].#subform[23].#subform[24].RadioButtonList[75]' } }, 'biological_stepchild_3' => { 'biological_stepchild_3_true' => { key: 'form1[0].#subform[23].#subform[24].RadioButtonList[63]' }, 'biological_stepchild_3_false' => { key: 'form1[0].#subform[23].#subform[24].RadioButtonList[64]' } }, 'biological_stepchild_4' => { 'biological_stepchild_4_true' => { key: 'form1[0].#subform[34].#subform[35].RadioButtonList[109]' }, 'biological_stepchild_4_false' => { key: 'form1[0].#subform[34].#subform[35].RadioButtonList[110]' } }, 'biological_stepchild_5' => { 'biological_stepchild_5_true' => { key: 'form1[0].#subform[34].#subform[35].RadioButtonList[120]' }, 'biological_stepchild_5_false' => { key: 'form1[0].#subform[34].#subform[35].RadioButtonList[121]' } } # end of biological stepchild }, # end of child status 'previous_marriage_details' => { 'date_marriage_ended' => { 'month' => { key: 'children_to_add.previous_marriage_details.date_marriage_ended.month[%iterator%]', limit: 2, question_num: 16, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > END DATE OF CHILDS MARRIAGE > MONTH' }, # end of month 'day' => { key: 'children_to_add.previous_marriage_details.date_marriage_ended.day[%iterator%]', limit: 2, question_num: 16, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > END DATE OF CHILDS MARRIAGE > DAY' }, # end of day 'year' => { key: 'children_to_add.previous_marriage_details.date_marriage_ended.year[%iterator%]', limit: 4, question_num: 16, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > END DATE OF CHILDS MARRIAGE > YEAR' } # end of year }, # end of date marriage ended 'reason_marriage_ended' => { 'declared_void' => { key: 'children_to_add.previous_marriage_details.reason_marriage_ended.declared_void[%iterator%]' }, 'annulled' => { key: 'children_to_add.previous_marriage_details.reason_marriage_ended.annulled[%iterator%]' }, 'other' => { key: 'children_to_add.previous_marriage_details.reason_marriage_ended.other[%iterator%]' } }, 'other_reason_marriage_ended' => { 'reason_marriage_ended_other_line1' => { key: 'children_to_add.previous_marriage_details.reason_marriage_ended_other.' \ 'reason_marriage_ended_other_line1[%iterator%]', limit: 8, question_num: 16, question_suffix: 'G', # after buttons? question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > END DATE OF CHILDS MARRIAGE > REASON LINE1' }, 'reason_marriage_ended_other_line2' => { key: 'children_to_add.previous_marriage_details.reason_marriage_ended_other.' \ 'reason_marriage_ended_other_line2[%iterator%]', limit: 8, question_num: 16, question_suffix: 'H', # after buttons? question_text: 'INFORMATION NEEDED TO ADD CHILD(REN) > END DATE OF CHILDS MARRIAGE > REASON LINE2' } } # end reason_marriage_ended_other } # end previous_marriage_details }, # end children_to_add # ------------ SECTION IV: VETERAN REPORTING DIVORCE FROM FORMER SPOUSE ----------------- # 'report_divorce' => { 'full_name' => { 'first' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].FORMERSPOUSEFIRST[0]', limit: 12, question_num: 20, question_suffix: 'A', question_text: 'VETERAN REPORTING DIVORCE FROM FORMER SPOUSE > NAME OF FORMER SPOUSE' }, 'middleInitial' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].FORMERSPOUSEMiddleInitial1[0]', limit: 1, question_num: 20, question_suffix: 'B', question_text: 'VETERAN REPORTING DIVORCE FROM FORMER SPOUSE > NAME OF FORMER SPOUSE' }, 'last' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].FORMERSPOUSELastName[0]', limit: 18, question_num: 20, question_suffix: 'C', question_text: 'VETERAN REPORTING DIVORCE FROM FORMER SPOUSE > NAME OF FORMER SPOUSE' } # @TODO 'suffix' => FE has suffix but no place for it on PDF }, # end full_name 'location' => { 'city' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].CurrentMailingAddress_City[27]', limit: 18, question_num: 20, question_suffix: 'A', question_text: 'VETERAN REPORTING DIVORCE FROM FORMER SPOUSE > PLACE OF DIVORCE' }, 'state' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].CurrentMailingAddress_StateOrProvince[27]', limit: 2, question_num: 20, question_suffix: 'B', question_text: 'VETERAN REPORTING DIVORCE FROM FORMER SPOUSE > PLACE OF DIVORCE' }, 'country' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].CurrentMailingAddress_Country[27]', limit: 2, question_num: 20, question_suffix: 'C', question_text: 'VETERAN REPORTING DIVORCE FROM FORMER SPOUSE > PLACE OF DIVORCE' } }, 'date' => { 'month' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].DATEOFDIVORCE_MONTH[0]', limit: 2, question_num: 20, question_suffix: 'A', question_text: 'VETERAN REPORTING DIVORCE FROM FORMER SPOUSE > DATE OF DIVORCE' }, 'day' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].DATEOFDIVORCE_DAY[0]', limit: 2, question_num: 20, question_suffix: 'B', question_text: 'VETERAN REPORTING DIVORCE FROM FORMER SPOUSE > DATE OF DIVORCE' }, 'year' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].DATEOFDIVORCE_YEAR[0]', limit: 4, question_num: 20, question_suffix: 'C', question_text: 'VETERAN REPORTING DIVORCE FROM FORMER SPOUSE > DATE OF DIVORCE' } }, 'reason_marriage_ended' => { # ??? this gets added to remarks section # NOTE: If marriage ended as an annulment or declared void, use Section IX, Item 25, Remarks to explain. } }, # end report_divorce # ----------------- SECTION V: VETERAN/CLAIMANT REPORTING ON STEPCHILD(REN) ----------------- # 'step_children' => { limit: 2, first_key: 'full_name', 'supporting_stepchild' => { 'supporting_stepchild_yes' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].RadioButtonList[79]' }, 'supporting_stepchild_no' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].RadioButtonList[78]' } }, # end of supporting_stepchild 'full_name' => { 'first' => { key: 'step_children.full_name.first[%iterator%]', limit: 12, question_num: 21, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > FIRST NAME' }, # end of first name of the stepchild you are supporting 'middleInitial' => { key: 'step_children.full_name.middleInitial[%iterator%]', limit: 1, question_num: 21, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > MIDDLE INITIAL' }, # end of middle initial of the stepchild you are supporting 'last' => { key: 'step_children.full_name.last[%iterator%]', limit: 18, question_num: 21, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LAST NAME' } # end of last name of the stepchild you are supporting }, 'who_does_the_stepchild_live_with' => { 'first' => { key: 'step_children.who_does_the_stepchild_live_with.first[%iterator%]', limit: 12, question_num: 21, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LIVING WITH WHO > FIRST NAME' }, # end of first 'middleInitial' => { key: 'step_children.who_does_the_stepchild_live_with.middleInitial[%iterator%]', limit: 1, question_num: 21, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LIVING WITH WHO > MIDDLE INITIAL' }, # end of middle 'last' => { key: 'step_children.who_does_the_stepchild_live_with.last[%iterator%]', limit: 18, question_num: 21, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LIVING WITH WHO > LAST NAME' } # end of last }, # end of who_does_the_stepchild_live_with 'address' => { 'address_line1' => { key: 'step_children.address.address_line1[%iterator%]', limit: 27, question_num: 21, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LIVING WHERE > STREET' }, 'address_line2' => { key: 'step_children.address.address_line2[%iterator%]', limit: 5, question_num: 21, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LIVING WHERE > STREET' }, 'city' => { key: 'step_children.address.city[%iterator%]', limit: 18, question_num: 21, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LIVING WHERE > CITY' }, 'state_code' => { key: 'step_children.address.state_code[%iterator%]', limit: 2, question_num: 21, question_suffix: 'D', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LIVING WHERE > STATE' }, 'country_name' => { key: 'step_children.address.country_name[%iterator%]', limit: 2, question_num: 21, question_suffix: 'E', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LIVING WHERE > COUNTRY' }, 'zip_code' => { 'firstFive' => { key: 'step_children.address.zip_code.firstFive[%iterator%]', limit: 5, question_num: 21, question_suffix: 'F', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LIVING WHERE > ZIPCODE FIRST FIVE' }, 'lastFour' => { key: 'step_children.address.zip_code.lastFour[%iterator%]', limit: 4, question_num: 21, question_suffix: 'G', question_text: 'INFORMATION NEEDED TO ADD A STEPCHILD > LIVING WHERE > ZIPCODE LAST FOUR' } } # end of zip_code }, # end of address # 21F. DATE STEPCHILD LEFT VETERAN'S HOUSEHOLD (MM-DD-YYYY) 'living_expenses_paid' => { 'more_than_half' => { key: 'step_children.living_expenses_paid.more_than_half[%iterator%]' }, 'half' => { key: 'step_children.living_expenses_paid.half[%iterator%]' }, 'less_than_half' => { key: 'step_children.living_expenses_paid.less_than_half[%iterator%]' } } # end of living_expenses_paid }, # end of step_children # ----------------- SECTION VI: VETERAN/CLAIMANT REPORTING DEATH OF A DEPENDENT ----------------- # 'deaths' => { limit: 2, first_key: 'full_name', 'dependent_type' => { 'spouse' => { key: 'deaths.dependent_type.spouse[%iterator%]' }, 'minor_child' => { key: 'deaths.dependent_type.minor_child[%iterator%]' }, 'stepchild' => { key: 'deaths.dependent_type.stepchild[%iterator%]' }, 'adopted' => { key: 'deaths.dependent_type.adopted[%iterator%]' }, 'dependent_parent' => { key: 'deaths.dependent_type.dependent_parent[%iterator%]' }, 'child_incapable_self_support' => { key: 'deaths.dependent_type.child_incapable_self_support[%iterator%]' }, '18_23_years_old_in_school' => { key: 'deaths.dependent_type.18_23_years_old_in_school[%iterator%]' } }, 'full_name' => { 'first' => { key: 'deaths.full_name.first[%iterator%]', limit: 12, question_num: 22, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO REPORT DEPEDENT DEATH > NAME > FIRST' }, 'middleInitial' => { key: 'deaths.full_name.middleInitial[%iterator%]', limit: 1, question_num: 22, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO REPORT DEPEDENT DEATH > NAME > MIDDLE INITIAL' }, 'last' => { key: 'deaths.full_name.last[%iterator%]', limit: 18, question_num: 22, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO REPORT DEPEDENT DEATH > NAME > LAST' } # @TODO 'suffix' => FE has suffix but no place for it on PDF }, # end of full name 'date' => { 'month' => { key: 'deaths.date.month[%iterator%]', limit: 2, question_num: 22, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO REPORT DEPEDENT DEATH > DATE > MONTH' }, 'day' => { key: 'deaths.date.day[%iterator%]', limit: 2, question_num: 22, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO REPORT DEPEDENT DEATH > DATE > DAY' }, 'year' => { key: 'deaths.date.year[%iterator%]', limit: 4, question_num: 22, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO REPORT DEPEDENT DEATH > DATE > YEAR' } }, # end of date of death 'location' => { 'city' => { key: 'deaths.location.city[%iterator%]', limit: 18, question_num: 22, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO REPORT DEPEDENT DEATH > PLACE > CITY' }, 'state' => { key: 'deaths.location.state[%iterator%]', limit: 2, question_num: 22, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO REPORT DEPEDENT DEATH > PLACE > STATE' }, 'country' => { key: 'deaths.location.country[%iterator%]', limit: 2, question_num: 22, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO REPORT DEPEDENT DEATH > PLACE > COUNTRY' } } # end location }, # end of deaths # ----------------- SECTION VII: VETERAN/CLAIMANT REPORTING MARRIAGE OF CHILD ----------------- # 'child_marriage' => { 'full_name' => { 'first' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].CHILDFirstName[30]', limit: 12, question_num: 23, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO REPORT MARRIAGE OF A CHILD > NAME > FIRST' }, # end of first name of married child 'middleInitial' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].CHILDMIDDLEName[0]', limit: 1, question_num: 23, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO REPORT MARRIAGE OF A CHILD > NAME > MIDDLE INITIAL' }, # end of middle initial name of married child 'last' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].CHILDLASTName[0]', limit: 18, question_num: 23, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO REPORT MARRIAGE OF A CHILD > NAME > LAST' } # @TODO 'suffix' => FE has suffix but no place for it on PDF }, # end full_name 'date_married' => { 'month' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].DateOfMarriage_Month[0]', limit: 2, question_num: 23, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO REPORT MARRIAGE OF CHILD > DATE > MONTH' }, 'day' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].DateOfMarriage_Day[0]', limit: 2, question_num: 23, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO REPORT MARRIAGE OF CHILD > DATE > DAY' }, 'year' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].DateOfMarriage_Year[0]', limit: 4, question_num: 23, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO REPORT MARRIAGE OF CHILD > DATE > YEAR' } } # end date_married }, # end of child marriage # --- SECTION VIII: VETERAN/CLAIMANT REPORTING A SCHOOLCHILD OVER 18 HAS STOPPED ATTENDING SCHOOL --- # 'child_stopped_attending_school' => { 'full_name' => { 'first' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].NAMEOFSCHOOLCHILDFirstName[0]', limit: 12, question_num: 24, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO REPORT CHILD STOPPED ATTENDING SCHOOL > NAME > FIRST' }, 'middleInitial' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].NAMEOFSCHOOLCHILDMIDDLEName[0]', limit: 1, question_num: 24, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO REPORT CHILD STOPPED ATTENDING SCHOOL > NAME > MIDDLE INITIAL' }, 'last' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].NAMEOFSCHOOLCHILDLASTName[0]', limit: 18, question_num: 24, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO REPORT CHILD STOPPED ATTENDING SCHOOL > NAME > LAST' } # @TODO 'suffix' => FE has suffix but no place for it on PDF }, 'date_child_left_school' => { 'month' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].DateSchoochildStoppedAttendingSchool_Month[0]', limit: 2, question_num: 24, question_suffix: 'A', question_text: 'INFORMATION NEEDED TO REPORT CHILD STOPPED ATTENDING SCHOOL > DATE > MONTH' }, 'day' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].DateSchoolchildStoppedAttendingSchool_Day[0]', limit: 2, question_num: 24, question_suffix: 'B', question_text: 'INFORMATION NEEDED TO REPORT CHILD STOPPED ATTENDING SCHOOL > DATE > DAY' }, 'year' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].DateSchoolchildStoppedAttendingSshool_Year[0]', limit: 4, question_num: 24, question_suffix: 'C', question_text: 'INFORMATION NEEDED TO REPORT CHILD STOPPED ATTENDING SCHOOL > DATE > YEAR' } } # end date_child_left_school } # end child_stopped_attending_school }, # end dependents_application # ----------------- SECTION IX: REMARKS ----------------- # 'remarks' => { 'remarks_line1' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[0]', limit: 35, question_num: 25, question_suffix: 'A', question_text: 'REMARKS' }, 'remarks_line2' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[1]', limit: 35, question_num: 25, question_suffix: 'B', question_text: 'REMARKS' }, 'remarks_line3' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[2]', limit: 35, question_num: 25, question_suffix: 'C', question_text: 'REMARKS' }, 'remarks_line4' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[3]', limit: 35, question_num: 25, question_suffix: 'D', question_text: 'REMARKS' }, 'remarks_line5' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[4]', limit: 35, question_num: 25, question_suffix: 'E', question_text: 'REMARKS' }, 'remarks_line6' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[5]', limit: 35, question_num: 25, question_suffix: 'F', question_text: 'REMARKS' }, 'remarks_line7' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[6]', limit: 35, question_num: 25, question_suffix: 'G', question_text: 'REMARKS' }, 'remarks_line8' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[7]', limit: 35, question_num: 25, question_suffix: 'H', question_text: 'REMARKS' }, 'remarks_line9' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[8]', limit: 35, question_num: 25, question_suffix: 'I', question_text: 'REMARKS' }, 'remarks_line10' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[9]', limit: 35, question_num: 25, question_suffix: 'J', question_text: 'REMARKS' }, 'remarks_line11' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[10]', limit: 35, question_num: 25, question_suffix: 'K', question_text: 'REMARKS' }, 'remarks_line12' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Remarks[11]', limit: 35, question_num: 25, question_suffix: 'L', question_text: 'REMARKS' } # @TODO remarks }, 'addendum' => { key: 'addendum' }, 'veteran_ssn' => { 'ssn1' => { 'first' => { key: 'form1[0].#subform[18].Veterans_SocialSecurityNumber_FirstThreeNumbers[1]' }, 'second' => { key: 'form1[0].#subform[18].Veterans_SocialSecurityNumber_SecondTwoNumbers[1]' }, 'third' => { key: 'form1[0].#subform[18].Veterans_SocialSecurityNumber_LastFourNumbers[1]' } }, 'ssn2' => { 'first' => { key: 'form1[0].#subform[19].#subform[20].Veterans_SocialSecurityNumber_FirstThreeNumbers[2]' }, 'second' => { key: 'form1[0].#subform[19].#subform[20].Veterans_SocialSecurityNumber_SecondTwoNumbers[2]' }, 'third' => { key: 'form1[0].#subform[19].#subform[20].Veterans_SocialSecurityNumber_LastFourNumbers[2]' } }, 'ssn3' => { 'first' => { key: 'form1[0].#subform[21].#subform[22].Veterans_SocialSecurityNumber_FirstThreeNumbers[3]' }, 'second' => { key: 'form1[0].#subform[21].#subform[22].Veterans_SocialSecurityNumber_SecondTwoNumbers[3]' }, 'third' => { key: 'form1[0].#subform[21].#subform[22].Veterans_SocialSecurityNumber_LastFourNumbers[3]' } }, 'ssn4' => { 'first' => { key: 'form1[0].#subform[23].#subform[24].Veterans_SocialSecurityNumber_FirstThreeNumbers[4]' }, 'second' => { key: 'form1[0].#subform[23].#subform[24].Veterans_SocialSecurityNumber_SecondTwoNumbers[4]' }, 'third' => { key: 'form1[0].#subform[23].#subform[24].Veterans_SocialSecurityNumber_LastFourNumbers[4]' } }, 'ssn5' => { 'first' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].Veterans_SocialSecurityNumber_FirstThreeNumbers[5]' }, 'second' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].Veterans_SocialSecurityNumber_SecondTwoNumbers[5]' }, 'third' => { key: 'form1[0].#subform[25].#subform[26].#subform[27].Veterans_SocialSecurityNumber_LastFourNumbers[5]' } }, 'ssn6' => { 'first' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].Veterans_SocialSecurityNumber_FirstThreeNumbers[6]' }, 'second' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].Veterans_SocialSecurityNumber_SecondTwoNumbers[6]' }, 'third' => { key: 'form1[0].#subform[28].#subform[29].#subform[30].Veterans_SocialSecurityNumber_LastFourNumbers[6]' } }, 'ssn7' => { 'first' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Veterans_SocialSecurityNumber_FirstThreeNumbers[7]' }, 'second' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Veterans_SocialSecurityNumber_SecondTwoNumbers[7]' }, 'third' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].Veterans_SocialSecurityNumber_LastFourNumbers[7]' } }, 'ssn8' => { 'first' => { key: 'form1[0].#subform[34].#subform[35].Veterans_SocialSecurityNumber_FirstThreeNumbers[8]' }, 'second' => { key: 'form1[0].#subform[34].#subform[35].Veterans_SocialSecurityNumber_SecondTwoNumbers[8]' }, 'third' => { key: 'form1[0].#subform[34].#subform[35].Veterans_SocialSecurityNumber_LastFourNumbers[8]' } } }, # end veteran_ssn 'signature' => { key: 'signature' }, 'signature_date' => { 'month' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].DateMM[0]' }, 'day' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].DateDD[0]' }, 'year' => { key: 'form1[0].#subform[31].#subform[32].#subform[33].DateYYYY[0]' } } # end signature_date }.freeze
Instance Method Summary collapse
Methods included from FormHelper
#address_block, #combine_date_ranges, #expand_checkbox_as_hash, #extract_country, #extract_middle_i, #format_boolean, #select_checkbox, #select_radio_button, #split_date, #split_postal_code, #split_ssn, #validate_date
Methods inherited from FormBase
#combine_both_addr, #combine_full_address, #combine_full_address_extras, #combine_full_name, #combine_hash, #combine_name_addr, #combine_name_addr_extras, #combine_postal_code, #combine_previous_names, date_strftime, #expand_checkbox, #expand_date_range, #expand_signature, #initialize
Constructor Details
This class inherits a constructor from PdfFill::Forms::FormBase
Instance Method Details
#merge_fields(_options = {}) ⇒ Object
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# File 'lib/pdf_fill/forms/va686c674.rb', line 1542 def merge_fields( = {}) merge_addendum_helpers merge_veteran_helpers merge_spouse_helpers merge_previous_marriage_helpers merge_spouse_marriage_history_helpers merge_child_helpers merge_divorce_helpers merge_stepchildren_helpers merge_death_helpers merge_child_marriage_helpers merge_child_stopped_attending_school_helpers (@form_data['veteran_information']['full_name']) @form_data['signature_date'] = split_date(@form_data['signatureDate']) @form_data end |