{
'claimantInformation' => {
'fullName' => {
'first' => {
key: 'F[0].Page_1[0].ClaimantsFirstName[0]',
limit: 12,
question_num: 1,
question_suffix: 'A',
question_text: 'NAME OF CLAIMANT'
},
'middleInitial' => {
key: 'F[0].Page_1[0].ClaimantsMiddleInitial[0]',
limit: 1,
question_num: 1,
question_suffix: 'B',
question_text: 'NAME OF CLAIMANT'
},
'last' => {
key: 'F[0].Page_1[0].ClaimantsLastName[0]',
limit: 18,
question_num: 1,
question_suffix: 'C',
question_text: 'NAME OF CLAIMANT'
}
}, 'ssn' => {
'first' => {
key: 'F[0].Page_1[0].SocialSecurityNumber_FirstThreeNumbers[0]',
limit: 3,
question_num: 1,
question_suffix: 'A',
question_text: 'SOCIAL SECURITY NUMBER OF APPLICANT'
},
'second' => {
key: 'F[0].Page_1[0].SocialSecurityNumber_SecondTwoNumbers[0]',
limit: 2,
question_num: 1,
question_suffix: 'B',
question_text: 'SOCIAL SECURITY NUMBER OF APPLICANT'
},
'third' => {
key: 'F[0].Page_1[0].SocialSecurityNumber_LastFourNumbers[0]',
limit: 4,
question_num: 1,
question_suffix: 'C',
question_text: 'SOCIAL SECURITY NUMBER OF APPLICANT'
}
}, 'dateOfBirth' => {
'month' => {
key: 'F[0].Page_1[0].DOBmonth[0]',
limit: 2,
question_num: 1,
question_suffix: 'A',
question_text: 'DATE OF BIRTH'
},
'day' => {
key: 'F[0].Page_1[0].DOBday[0]',
limit: 2,
question_num: 1,
question_suffix: 'B',
question_text: 'DATE OF BIRTH'
},
'year' => {
key: 'F[0].Page_1[0].DOByear[0]',
limit: 4,
question_num: 1,
question_suffix: 'C',
question_text: 'DATE OF BIRTH'
}
},
'vaFileNumber' => {
key: 'F[0].Page_1[0].VAFileNumber[0]',
limit: 8,
question_num: 1,
question_suffix: 'A',
question_text: 'VA FILE NUMBER'
},
'emailAddress' => {
key: 'F[0].Page_1[0].Email_Address[0]',
limit: 30,
question_num: 2,
question_suffix: 'A',
question_text: 'APPLICANT\'S E-MAIL ADDRESS'
},
'phoneNumber' => {
'phone_area_code' => {
key: 'F[0].Page_1[0].TelephoneNumber_AreaCode[0]',
limit: 3,
question_num: 3,
question_suffix: 'A',
question_text: 'TELEPHONE NUMBER'
},
'phone_first_three_numbers' => {
key: 'F[0].Page_1[0].TelephoneNumber_FirstThreeNumbers[0]',
limit: 3,
question_num: 3,
question_suffix: 'B',
question_text: 'TELEPHONE NUMBER'
},
'phone_last_four_numbers' => {
key: 'F[0].Page_1[0].TelephoneNumber_LastFourNumbers[0]',
limit: 4,
question_num: 3,
question_suffix: 'C',
question_text: 'TELEPHONE NUMBER'
}
}
}, 'claimantAddress' => {
'street' => {
key: 'F[0].Page_1[0].CurrentMailingAddress_NumberAndStreet[0]',
limit: 30,
question_num: 3,
question_suffix: 'A',
question_text: 'MAILING ADDRESS'
},
'city' => {
key: 'F[0].Page_1[0].CurrentMailingAddress_City[0]',
limit: 18,
question_num: 3,
question_suffix: 'C',
question_text: 'MAILING ADDRESS'
},
'state' => {
key: 'F[0].Page_1[0].CurrentMailingAddress_StateOrProvince[0]',
limit: 2,
question_num: 3,
question_suffix: 'D',
question_text: 'MAILING ADDRESS'
},
'country' => {
key: 'F[0].Page_1[0].CurrentMailingAddress_Country[0]',
limit: 2,
question_num: 3,
question_suffix: 'E',
question_text: 'MAILING ADDRESS'
},
'postalCode' => {
'firstFive' => {
key: 'F[0].Page_1[0].CurrentMailingAddress_ZIPOrPostalCode_FirstFiveNumbers[0]',
limit: 5,
question_num: 3,
question_suffix: 'F',
question_text: 'MAILING ADDRESS'
},
'lastFour' => {
key: 'F[0].Page_1[0].CurrentMailingAddress_ZIPOrPostalCode_LastFourNumbers[0]',
limit: 4,
question_num: 3,
question_suffix: 'G',
question_text: 'MAILING ADDRESS'
}
} }, 'relationship' => {
key: 'F[0].Page_1[0].RadioButtonList[1]'
}, 'veteranFullName' => {
'first' => {
key: 'F[0].Page_1[0].ClaimantsFirstName[1]',
limit: 12,
question_num: 6,
question_suffix: 'A',
question_text: 'NAME OF VETERAN OR INDIVIDUAL ON ACTIVE DUTY ON WHOSE ACCOUNT BENEFITS ARE CLAIMED'
},
'middleInitial' => {
key: 'F[0].Page_1[0].ClaimantsMiddleInitial[1]',
limit: 1,
question_num: 6,
question_suffix: 'B',
question_text: 'NAME OF VETERAN OR INDIVIDUAL ON ACTIVE DUTY ON WHOSE ACCOUNT BENEFITS ARE CLAIMED'
},
'last' => {
key: 'F[0].Page_1[0].ClaimantsLastName[1]',
limit: 18,
question_num: 6,
question_suffix: 'C',
question_text: 'NAME OF VETERAN OR INDIVIDUAL ON ACTIVE DUTY ON WHOSE ACCOUNT BENEFITS ARE CLAIMED'
}
}, 'ssn' => {
'first' => {
key: 'F[0].Page_1[0].VeteransSocialSecurityNumber_FirstThreeNumbers[0]',
limit: 3,
question_num: 6,
question_suffix: 'A',
question_text: 'SOCIAL SECURITY NUMBER'
},
'second' => {
key: 'F[0].Page_1[0].VeteransSocialSecurityNumber_SecondTwoNumbers[0]',
limit: 2,
question_num: 6,
question_suffix: 'B',
question_text: 'SOCIAL SECURITY NUMBER'
},
'third' => {
key: 'F[0].Page_1[0].VeteransSocialSecurityNumber_LastFourNumbers[0]',
limit: 4,
question_num: 6,
question_suffix: 'C',
question_text: 'SOCIAL SECURITY NUMBER'
}
},
'dob' => {
'month' => {
key: 'F[0].Page_1[0].DOBmonth[1]',
limit: 2,
question_num: 7,
question_suffix: 'A',
question_text: 'DATE OF BIRTH'
},
'day' => {
key: 'F[0].Page_1[0].DOBday[1]',
limit: 2,
question_num: 7,
question_suffix: 'B',
question_text: 'DATE OF BIRTH'
},
'year' => {
key: 'F[0].Page_1[0].DOByear[1]',
limit: 4,
question_num: 7,
question_suffix: 'C',
question_text: 'DATE OF BIRTH'
}
},
'vaFileNumber' => {
key: 'F[0].Page_1[0].VETERANS_VAFileNumber[0]',
limit: 8,
question_num: 6,
question_suffix: 'A',
question_text: 'VA FILE NUMBER'
},
'serviceNumber' => {
key: 'F[0].Page_1[0].VAFileNumber[2]',
limit: 8,
question_num: 9,
question_suffix: 'A',
question_text: 'SERVICE NUMBER'
},
'veteranSsn' => {
'first' => { key: 'F[0].Page_2[0].VeteransSocialSecurityNumber_FirstThreeNumbers[0]' },
'second' => { key: 'F[0].Page_2[0].VeteransSocialSecurityNumber_SecondTwoNumbers[0]' },
'third' => { key: 'F[0].Page_2[0].VeteransSocialSecurityNumber_LastFourNumbers[0]' }
},
'signature' => {
key: 'signature'
},
'signatureDate' => {
'month' => {
key: 'F[0].Page_2[0].DOBmonth[0]'
},
'day' => {
key: 'F[0].Page_2[0].DOBday[0]'
},
'year' => {
key: 'F[0].Page_2[0].DOByear[0]'
}
}, 'claimantName' => { key: 'claimantName' },
'claimantSsn' => { key: 'claimantSsn' },
'claimantDob' => { key: 'claimantDob' },
'claimantVaFileNumber' => { key: 'claimantVaFileNumber' },
'claimantEmail' => { key: 'claimantEmail' },
'claimantRelationship' => { key: 'claimantRelationship' },
'claimantTelephone' => { key: 'claimantTelephone' },
'claimantMailingAddress' => { key: 'claimantMailingAddress' },
'veteranName' => { key: 'veteranName' },
'veteranSocialSecurityNumber' => { key: 'veteranSocialSecurityNumber' },
'veteranVaFileNumber' => { key: 'veteranVaFileNumber' }
}.freeze