{
'helpers' => {
'veteranFullName' => { key: INPUT_MAP.veteran[:name], question_num: 3 },
'gender' => { key: INPUT_MAP.veteran[:gender], question_num: 6 },
'sigiGenders' => { key: INPUT_MAP.veteran[:sigi_genders], question_num: 7 },
'placeOfBirth' => { key: INPUT_MAP.veteran[:place_of_birth], question_num: 12 },
'isAmericanIndianOrAlaskanNative' => {
key: INPUT_MAP.veteran[:ethnicity][:isAmericanIndianOrAlaskanNative],
question_num: 9
},
'isAsian' => { key: INPUT_MAP.veteran[:ethnicity][:isAsian], question_num: 9 },
'isBlackOrAfricanAmerican' => {
key: INPUT_MAP.veteran[:ethnicity][:isBlackOrAfricanAmerican],
question_num: 9
},
'isSpanishHispanicLatino' => {
key: INPUT_MAP.veteran[:ethnicity][:isSpanishHispanicLatino],
question_num: 8
},
'isNativeHawaiianOrOtherPacificIslander' => {
key: INPUT_MAP.veteran[:ethnicity][:isNativeHawaiianOrOtherPacificIslander],
question_num: 9
},
'isWhite' => { key: INPUT_MAP.veteran[:ethnicity][:isWhite], question_num: 9 },
'hasDemographicNoAnswer' => {
key: INPUT_MAP.veteran[:ethnicity][:hasDemographicNoAnswer], question_num: 9
},
'maritalStatus' => { key: INPUT_MAP.veteran[:marital_status], question_num: 28 },
'wantsInitialVaContact' => { key: INPUT_MAP.veteran[:initial_va_contact], question_num: 37 },
'purpleHeartRecipient' => { key: INPUT_MAP.veteran[:service][:purple_heart_recipient] },
'isFormerPow' => { key: INPUT_MAP.veteran[:service][:is_former_pow] },
'postNov111998Combat' => { key: INPUT_MAP.veteran[:service][:post_11111998_combat] },
'disabledInLineOfDuty' => { key: INPUT_MAP.veteran[:service][:disabled_in_lod] },
'swAsiaCombat' => { key: INPUT_MAP.veteran[:service][:sw_asia_combat] },
'vietnamService' => { key: INPUT_MAP.veteran[:service][:vietnam_service] },
'exposedToRadiation' => { key: INPUT_MAP.veteran[:service][:exposed_to_radiation] },
'radiumTreatments' => { key: INPUT_MAP.veteran[:service][:radium_treatments] },
'campLejeune' => { key: INPUT_MAP.veteran[:service][:camp_lejeune] },
'isMedicaidEligible' => { key: INPUT_MAP.is_medicaid_eligible },
'isEnrolledMedicarePartA' => { key: INPUT_MAP.is_enrolled_nedicare_part_a },
'providers' => {
'insuranceName' => { key: INPUT_MAP.providers[:insurance_name] },
'insurancePolicyHolderName' => { key: INPUT_MAP.providers[:insurance_policy_holder_name] },
'insurancePolicyNumber' => { key: INPUT_MAP.providers[:insurance_policy_number] },
'insuranceGroupCode' => { key: INPUT_MAP.providers[:insurance_group_code] }
},
'dependents' => {
'fullName' => { key: INPUT_MAP.dependents[:name] },
'dependentRelation' => { key: INPUT_MAP.dependents[:relation] },
'socialSecurityNumber' => { key: INPUT_MAP.dependents[:ssn] },
'dateOfBirth' => { key: INPUT_MAP.dependents[:date_of_birth] },
'becameDependent' => { key: INPUT_MAP.dependents[:became_dependent] },
'attendedSchoolLastYear' => { key: INPUT_MAP.dependents[:attend_school_last_year] },
'disabledBefore18' => { key: INPUT_MAP.dependents[:disabled_before18] },
'grossIncome' => { key: INPUT_MAP.dependents[:gross_income] },
'netIncome' => { key: INPUT_MAP.dependents[:net_income] },
'otherIncome' => { key: INPUT_MAP.dependents[:other_income] }
},
'spouseFullName' => { key: INPUT_MAP.spouse[:name] },
'spouseAddress' => { key: INPUT_MAP.spouse[:address] },
'cohabitedLastYear' => { key: INPUT_MAP.spouse[:cohabitated_last_year] },
'veteranDateOfBirth' => { key: INPUT_MAP.veteran[:date_of_birth], question_num: 11 },
'lastEntryDate' => { key: INPUT_MAP.veteran[:service][:last_entry_date] },
'lastDischargeDate' => { key: INPUT_MAP.veteran[:service][:last_discharge_date] },
'medicarePartAEffectiveDate' => { key: INPUT_MAP.medicare_effective_date },
'spouseDateOfBirth' => { key: INPUT_MAP.spouse[:date_of_birth] },
'dateOfMarriage' => { key: INPUT_MAP.spouse[:date_of_marriage] },
'discloseFinancialInformation' => { key: INPUT_MAP.veteran[:disclose_financial_information] }
},
'mothersMaidenName' => { key: INPUT_MAP.veteran[:mothers_maiden_name], question_num: 5 },
'veteranSocialSecurityNumber' => { key: INPUT_MAP.veteran[:ssn], question_num: 10 },
'email' => { key: INPUT_MAP.veteran[:email], question_num: 22 },
'homePhone' => { key: INPUT_MAP.veteran[:home_phone], question_num: 20 },
'mobilePhone' => { key: INPUT_MAP.veteran[:mobile_phone], question_num: 21 },
'veteranAddress' => {
'street' => { key: INPUT_MAP.veteran[:address][:street], question_num: 15 },
'city' => { key: INPUT_MAP.veteran[:address][:city], question_num: 16 },
'postalCode' => { key: INPUT_MAP.veteran[:address][:postalCode], question_num: 18 },
'state' => { key: INPUT_MAP.veteran[:address][:state], question_num: 17 }
},
'veteranHomeAddress' => {
'street' => { key: INPUT_MAP.veteran[:home_address][:street], question_num: 23 },
'city' => { key: INPUT_MAP.veteran[:home_address][:city], question_num: 24 },
'postalCode' => { key: INPUT_MAP.veteran[:home_address][:postalCode], question_num: 26 },
'state' => { key: INPUT_MAP.veteran[:home_address][:state], question_num: 25 }
},
'lastServiceBranch' => { key: INPUT_MAP.veteran[:service][:last_branch_of_service] },
'dischargeType' => { key: INPUT_MAP.veteran[:service][:discharge_type] },
'medicareClaimNumber' => { key: INPUT_MAP.medicare_number },
'spouseGrossIncome' => { key: INPUT_MAP.spouse[:gross_income] },
'spouseNetIncome' => { key: INPUT_MAP.spouse[:net_income] },
'spouseOtherIncome' => { key: INPUT_MAP.spouse[:other_income] },
'veteranGrossIncome' => { key: INPUT_MAP.veteran[:gross_income] },
'veteranNetIncome' => { key: INPUT_MAP.veteran[:net_income] },
'veteranOtherIncome' => { key: INPUT_MAP.veteran[:other_income] },
'deductibleMedicalExpenses' => { key: INPUT_MAP.deductible_medical_expenses },
'deductibleFuneralExpenses' => { key: INPUT_MAP.deductible_funeral_expenses },
'deductibleEducationExpenses' => { key: INPUT_MAP.deductible_education_expenses }
}.freeze