{
'veteranInformation' => {
'fullName' => {
'first' => {
key: 'VBA281900[0].#subform[0].Claimants_First_Name[0]',
limit: 12,
question_num: 1,
question_suffix: 'A',
question_text: 'NAME OF CLAIMANT'
},
'middleInitial' => {
key: 'VBA281900[0].#subform[0].Middle_Initial1[0]',
limit: 1,
question_num: 1,
question_suffix: 'B',
question_text: 'NAME OF CLAIMANT'
},
'last' => {
key: 'VBA281900[0].#subform[0].Last_Name[0]',
limit: 18,
question_num: 1,
question_suffix: 'C',
question_text: 'NAME OF CLAIMANT'
}
}, 'ssn' => {
'first' => {
key: 'VBA281900[0].#subform[0].SocialSecurityNumber_FirstThreeNumbers[0]',
limit: 3,
question_num: 2,
question_suffix: 'A',
question_text: 'SOCIAL SECURITY NUMBER'
},
'second' => {
key: 'VBA281900[0].#subform[0].SocialSecurityNumber_SecondTwoNumbers[0]',
limit: 2,
question_num: 2,
question_suffix: 'B',
question_text: 'SOCIAL SECURITY NUMBER'
},
'third' => {
key: 'VBA281900[0].#subform[0].SocialSecurityNumber_LastFourNumbers[0]',
limit: 4,
question_num: 2,
question_suffix: 'C',
question_text: 'SOCIAL SECURITY NUMBER'
}
},
'VAFileNumber' => {
key: 'VBA281900[0].#subform[0].VA_File_Number[0]',
limit: 9,
question_num: 3,
question_suffix: 'A',
question_text: 'VA FILE NUMBER'
},
'dob' => {
'month' => {
key: 'VBA281900[0].#subform[0].DOB_Month[0]',
limit: 2,
question_num: 4,
question_suffix: 'A',
question_text: 'DATE OF BIRTH'
},
'day' => {
key: 'VBA281900[0].#subform[0].DOB_Day[0]',
limit: 2,
question_num: 4,
question_suffix: 'B',
question_text: 'DATE OF BIRTH'
},
'year' => {
key: 'VBA281900[0].#subform[0].DOB_Year[0]',
limit: 4,
question_num: 4,
question_suffix: 'C',
question_text: 'DATE OF BIRTH'
}
}
}, 'veteranAddress' => {
'addressLine1' => {
key: 'VBA281900[0].#subform[0].Mailing_Address1[0]',
limit: 30,
question_num: 5,
question_suffix: 'A',
question_text: 'MAILING ADDRESS'
},
'addressLine2' => {
key: 'VBA281900[0].#subform[0].Mailing_Address1[1]',
limit: 30,
question_num: 5,
question_suffix: 'B',
question_text: 'MAILING ADDRESS'
},
'addressLine3' => {
key: 'VBA281900[0].#subform[0].Mailing_Address1[2]',
limit: 30,
question_num: 5,
question_suffix: 'C',
question_text: 'MAILING ADDRESS'
}
}, 'mainPhone' => {
'phone_area_code' => {
key: 'VBA281900[0].#subform[0].TelephoneNumber_AreaCode[0]',
limit: 3,
question_num: 6,
question_suffix: 'A',
question_text: 'MAIN TELEPHONE NUMBER'
},
'phone_first_three_numbers' => {
key: 'VBA281900[0].#subform[0].TelephoneNumber_FirstThreeNumbers[0]',
limit: 3,
question_num: 6,
question_suffix: 'B',
question_text: 'MAIN TELEPHONE NUMBER'
},
'phone_last_four_numbers' => {
key: 'VBA281900[0].#subform[0].TelephoneNumber_LastFourNumbers[0]',
limit: 4,
question_num: 6,
question_suffix: 'C',
question_text: 'MAIN TELEPHONE NUMBER'
}
},
'email' => {
key: 'VBA281900[0].#subform[0].Email_Address[0]',
limit: 30,
question_num: 7,
question_suffix: 'A',
question_text: 'E-MAIL ADDRESS OF CLAIMANT'
},
'cellPhone' => {
'phone_area_code' => {
key: 'VBA281900[0].#subform[0].Cell_Phone_Number_AreaCode[0]',
limit: 3,
question_num: 8,
question_suffix: 'A',
question_text: 'CELL PHONE NUMBER'
},
'phone_first_three_numbers' => {
key: 'VBA281900[0].#subform[0].Cell_Phone_Number_FirstThreeNumbers[0]',
limit: 3,
question_num: 8,
question_suffix: 'B',
question_text: 'CELL PHONE NUMBER'
},
'phone_last_four_numbers' => {
key: 'VBA281900[0].#subform[0].Cell_PhoneNumber_LastFourNumbers[0]',
limit: 4,
question_num: 8,
question_suffix: 'C',
question_text: 'CELL PHONE NUMBER'
}
},
'newAddress' => {
'addressLine1' => {
key: 'VBA281900[0].#subform[0].Address1[0]',
limit: 30,
question_num: 9,
question_suffix: 'A',
question_text: 'NEW ADDRESS IF MOVING WITHIN THE NEXT 30 DAYS'
},
'addressLine2' => {
key: 'VBA281900[0].#subform[0].Address1[1]',
limit: 30,
question_num: 9,
question_suffix: 'B',
question_text: 'NEW ADDRESS IF MOVING WITHIN THE NEXT 30 DAYS'
},
'addressLine3' => {
key: 'VBA281900[0].#subform[0].Address1[2]',
limit: 30,
question_num: 9,
question_suffix: 'C',
question_text: 'NEW ADDRESS IF MOVING WITHIN THE NEXT 30 DAYS'
}
}, 'yearsOfEducation' => {
key: 'VBA281900[0].#subform[0].Number_Of_Years_Of_Education[0]',
limit: 2,
question_num: 10,
question_suffix: 'A',
question_text: 'NUMBER OF YEARS OF EDUCATION'
},
'signature' => {
key: 'SignatureField'
},
'date_signed' => {
'month' => {
key: 'VBA281900[0].#subform[0].Date_Signed_Month[0]'
},
'day' => {
key: 'VBA281900[0].#subform[0].Date_Signed_Day[0]'
},
'year' => {
key: 'VBA281900[0].#subform[0].Date_Signed_Year[0]'
}
}, 'useEva' => {
key: 'useEva'
},
'useTelecounseling' => {
key: 'useTelecounseling'
},
'appointmentTimePreferences' => {
key: 'appointmentTimePreferences'
}
}.freeze