Class: PdfFill::Forms::Va686c674

Inherits:
FormBase
  • Object
show all
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'
        }
      },
      'international_phone_number' => {
        key: 'form1[0].#subform[17].TelephoneNumber_International[0]',
        limit: 13,
        question_num: 8,
        question_suffix: 'C',
        question_text: 'VETERAN/CLAIMANT\'S IDENTIFICATION INFORMATION > Enter International Phone 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'
      },
      'electronic_correspondence' => {
        key: 'form1[0].#subform[17].EmailAddressConsent[0]'
      },
      '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
        key: 'form1[0].#subform[17].SpouseVAFileNumber[0]',
        limit: 9,
        question_num: 12,
        question_suffix: 'B',
        question_text: 'Spouse\'s VA File Number (If Applicable)'
      }, # 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' => {
        'civil_ceremony' => {
          key: 'form1[0].#subform[17].CivilCeremony[0]'
        },
        '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: 'veteran.previousSpouse.middleInitial[%iterator%]',
          limit: 1,
          question_num: 14,
          question_suffix: 'B',
          question_text: 'PREVIOUS MARRIAGE HISTORY >  PREVIOUS SPOUSE MIDDLE INITIAL'
        },
        'last' => {
          key: 'veteran.previousSpouse.lastName[%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: 'children_to_add.child_status.biological_stepchild.yes[0]'
          },
          'biological_stepchild_0_false' => {
            key: 'children_to_add.child_status.biological_stepchild.no[0]'
          }
        },
        'biological_stepchild_1' => {
          'biological_stepchild_1_true' => {
            key: 'children_to_add.child_status.biological_stepchild.yes[1]'
          },
          'biological_stepchild_1_false' => {
            key: 'children_to_add.child_status.biological_stepchild.no[1]'
          }
        },
        'biological_stepchild_2' => {
          'biological_stepchild_2_true' => {
            key: 'children_to_add.child_status.biological_stepchild.yes[2]'
          },
          'biological_stepchild_2_false' => {
            key: 'children_to_add.child_status.biological_stepchild.no[2]'
          }
        },
        'biological_stepchild_3' => {
          'biological_stepchild_3_true' => {
            key: 'children_to_add.child_status.biological_stepchild.yes[3]'
          },
          'biological_stepchild_3_false' => {
            key: 'children_to_add.child_status.biological_stepchild.no[3]'
          }
        },
        'biological_stepchild_4' => {
          'biological_stepchild_4_true' => {
            key: 'children_to_add.child_status.biological_stepchild.yes[4]'
          },
          'biological_stepchild_4_false' => {
            key: 'children_to_add.child_status.biological_stepchild.no[4]'
          }
        },
        'biological_stepchild_5' => {
          'biological_stepchild_5_true' => {
            key: 'children_to_add.child_status.biological_stepchild.yes[5]'
          },
          'biological_stepchild_5_false' => {
            key: 'children_to_add.child_status.biological_stepchild.no[5]'
          }
        } # 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 Attribute Summary

Attributes inherited from FormBase

#form_data

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

#add_dependent_income(dependent_name, dependent_income) ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1954

def add_dependent_income(dependent_name, dependent_income)
  return '' if dependent_name.blank?

  "\n\nDid #{dependent_name} have an income in the last 365 days? #{format_boolean(dependent_income)}"
end

#add_dependents(dependents_hash, income_attr) ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1960

def add_dependents(dependents_hash, income_attr)
  return '' if dependents_hash.blank?

  dependent_text = ''
  dependents_hash.each do |dependent|
    dependent_name = combine_full_name(dependent['full_name'])
    dependent_income = dependent[income_attr]
    dependent_text += add_dependent_income(dependent_name, dependent_income)
  end

  dependent_text
end

#add_household_income ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1949

def add_household_income
  net_worth = @form_data.dig('dependents_application', 'household_income')
  "Did the household have a net worth greater than $130,773 in the last tax year? #{format_boolean(net_worth)}"
end

#expand_child_previously_married(child) ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1732

def expand_child_previously_married(child)
  return unless child['previously_married'] == 'Yes'

  child['child_status']['child_previously_married'] = 0

  # extract date
  child['previous_marriage_details']['date_marriage_ended'] =
    split_date(child.dig('previous_marriage_details', 'date_marriage_ended'))

  # expand reason child marriage ended
  reason_marriage_ended = child.dig('previous_marriage_details', 'reason_marriage_ended')
  if reason_marriage_ended.include?('Divorce') || reason_marriage_ended.include?('Death')
    # we show 'Divorce' and 'Death' as options on the FE as opposed to 'Declared Void'
    reason_marriage_ended = 'Declared Void'
  end
  child['previous_marriage_details']['reason_marriage_ended'] = {
    'declared_void' => select_radio_button(reason_marriage_ended == 'Declared Void'),
    'annulled' => select_radio_button(reason_marriage_ended == 'Annulment'),
    'other' => select_radio_button(reason_marriage_ended == 'Other')
  }

  expand_other_reason_marriage_ended(child)
end

#expand_child_status(child, index) ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1710

def expand_child_status(child, index)
  # expand child status
  child_status = child['child_status']
  date_became_dependent = split_date(child.dig('child_status', 'date_became_dependent'))
  biological_stepchild_key = "biological_stepchild_#{index}"
  # @TODO 18-23 YEARS OLD AND IN SCHOOL
  child['child_status'] = {
    'biological' => select_radio_button(child_status['biological']),
    'school_age_in_school' => select_radio_button(child_status['school_age_in_school']),
    'adopted' => select_radio_button(child_status['adopted']),
    'incapable_self_support' => select_radio_button(child['not_self_sufficient']),
    'child_previously_married' => select_radio_button(child_status['child_previously_married']),
    'stepchild' => select_radio_button(child_status['stepchild']),
    biological_stepchild_key => {
      "#{biological_stepchild_key}_true" => select_radio_button(child_status['biological_stepchild']),
      "#{biological_stepchild_key}_false" => child_status.key?('biological_stepchild') ? select_radio_button(!child_status['biological_stepchild']) : 'Off' # rubocop:disable Layout/LineLength
    }
  }

  child['child_status']['date_became_dependent'] = date_became_dependent if date_became_dependent.present?
end

#expand_does_live_with_spouse ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1899

def expand_does_live_with_spouse
  does_live_with_spouse =
    @form_data.dig('dependents_application', 'does_live_with_spouse', 'spouse_does_live_with_veteran')
  @form_data['dependents_application']['does_live_with_spouse']['spouse_does_live_with_veteran'] = {
    'spouse_does_live_with_veteran_yes' => select_radio_button(does_live_with_spouse),
    'spouse_does_live_with_veteran_no' => select_radio_button(!does_live_with_spouse)
  }
end

#expand_marriage_info ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1880

def expand_marriage_info
  # extract marriage date
  @form_data['dependents_application']['current_marriage_information']['date'] =
    split_date(@form_data.dig('dependents_application', 'current_marriage_information', 'date'))

  marriage_type = @form_data.dig('dependents_application', 'current_marriage_information', 'type')
  @form_data['dependents_application']['current_marriage_information']['type'] = {
    'civil_ceremony' => select_radio_button(marriage_type == 'CIVIL'),
    'religious_ceremony' => select_radio_button(marriage_type == 'CEREMONIAL'),
    'common_law' => select_radio_button(marriage_type == 'COMMON-LAW'),
    'tribal' => select_radio_button(marriage_type == 'TRIBAL'),
    'proxy' => select_radio_button(marriage_type == 'PROXY'),
    'other' => select_radio_button(marriage_type == 'OTHER')
  }

  @form_data['dependents_application']['current_marriage_information']['location']['country'] =
    extract_country(@form_data.dig('dependents_application', 'current_marriage_information', 'location'))
end

#expand_other_reason_marriage_ended(child) ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1756

def expand_other_reason_marriage_ended(child)
  other_reason_marriage_ended = child.dig('previous_marriage_details', 'other_reason_marriage_ended')
  if other_reason_marriage_ended.present?
    child['previous_marriage_details']['other_reason_marriage_ended'] = {}
    if other_reason_marriage_ended.length > 8 && other_reason_marriage_ended.length < 16
      child['previous_marriage_details']['other_reason_marriage_ended']['reason_marriage_ended_other_line1'] =
        other_reason_marriage_ended[0..7]
      child['previous_marriage_details']['other_reason_marriage_ended']['reason_marriage_ended_other_line2'] =
        other_reason_marriage_ended[8..15]
    else
      child['previous_marriage_details']['other_reason_marriage_ended']['reason_marriage_ended_other_line1'] =
        other_reason_marriage_ended
    end
  end
end

#expand_phone_number(veteran_contact_information) ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1868

def expand_phone_number(veteran_contact_information)
  phone_number = veteran_contact_information['phone_number']
  if phone_number.present?
    phone_number = phone_number.delete('^0-9')
    veteran_contact_information['phone_number'] = {
      'phone_area_code' => phone_number[0..2],
      'phone_first_three_numbers' => phone_number[3..5],
      'phone_last_four_numbers' => phone_number[6..9]
    }
  end
end

#expand_remarks ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1908

def expand_remarks
  @form_data['remarks'] = {}
  # @TODO FE changes for remarks
  # 12.times do |i|
  #   @form_data['remarks']['remarks_line' + (i + 1).to_s] = ""
  # end
end

#expand_veteran_ssn ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1916

def expand_veteran_ssn
  # veteran ssn is repeated at the top of 8 pages
  veteran_ssn = @form_data['veteran_information']['ssn']
  @form_data['veteran_ssn'] = {}
  8.times do |i|
    @form_data['veteran_ssn']["ssn#{i + 1}"] = veteran_ssn
  end
end

#merge_addendum_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1925

def merge_addendum_helpers
  addendum_text = add_household_income

  # income question when adding spouse
  spouse_name = combine_full_name(@form_data.dig('dependents_application', 'spouse_information', 'full_name'))
  spouse_income = @form_data.dig('dependents_application', 'does_live_with_spouse', 'spouse_income')
  addendum_text += add_dependent_income(spouse_name, spouse_income)

  # income questions when adding children
  children_to_add = @form_data.dig('dependents_application', 'children_to_add')
  addendum_text += add_dependents(children_to_add, 'child_income')

  # income question when reporting a divorce
  spouse_name = combine_full_name(@form_data.dig('dependents_application', 'report_divorce', 'full_name'))
  spouse_income = @form_data.dig('dependents_application', 'report_divorce', 'spouse_income')
  addendum_text += add_dependent_income(spouse_name, spouse_income)

  # income questions when reporting deaths
  deaths = @form_data.dig('dependents_application', 'deaths')
  addendum_text += add_dependents(deaths, 'dependent_income')

  @form_data['addendum'] = addendum_text
end

#merge_child_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1680

def merge_child_helpers
  children_to_add = @form_data['dependents_application']['children_to_add']
  return if children_to_add.blank?

  children_to_add.each_with_index do |child, index|
    # extract middle initial
    child['full_name'] = extract_middle_i(child, 'full_name')

    # extract birth date
    child['birth_date'] = split_date(child['birth_date'])

    # extract ssn
    child['ssn'] = split_ssn(child['ssn'].delete('-')) if child['ssn'].present?

    # extract country: FE uses 3 char country codes, but pdf expects 2 char country code
    child['place_of_birth']['country'] = extract_country(child['place_of_birth'])

    # extract postal code and country
    unless child['does_child_live_with_you']
      child['child_address_info']['address']['zip_code'] =
        split_postal_code(child.dig('child_address_info', 'address'))
      child['child_address_info']['address']['country_name'] =
        extract_country(child.dig('child_address_info', 'address'))
    end

    expand_child_status(child, index)
    expand_child_previously_married(child)
  end
end

#merge_child_marriage_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1845

def merge_child_marriage_helpers
  child_marriage = @form_data['dependents_application']['child_marriage']
  return if child_marriage.blank?

  # extract middle initial
  child_marriage['full_name'] = extract_middle_i(child_marriage, 'full_name')

  # extract date
  child_marriage['date_married'] = split_date(child_marriage['date_married'])
end

#merge_child_stopped_attending_school_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1856

def merge_child_stopped_attending_school_helpers
  child_stopped_attending_school = @form_data['dependents_application']['child_stopped_attending_school']
  return if child_stopped_attending_school.blank?

  # extract middle initial
  child_stopped_attending_school['full_name'] = extract_middle_i(child_stopped_attending_school, 'full_name')

  # extract date
  child_stopped_attending_school['date_child_left_school'] =
    split_date(child_stopped_attending_school['date_child_left_school'])
end

#merge_death_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1813

def merge_death_helpers
  deaths = @form_data['dependents_application']['deaths']
  return if deaths.blank?

  deaths.each do |death|
    # extract middle initial
    death['full_name'] = extract_middle_i(death, 'full_name')

    # extract date
    death['date'] = split_date(death['date'])

    # extract country: FE uses 3 char country codes, but pdf expects 2 char country code
    death['location']['country'] = extract_country(death['location'])

    # expand dependent type
    dependent_type = death['dependent_type']
    if dependent_type == 'CHILD'
      # ex. "dependent_type":"CHILD","child_status":{"child_under18":true,"step_child":true}
      dependent_type = death['child_status']
    end
    death['dependent_type'] = {
      'spouse' => select_radio_button(dependent_type == 'SPOUSE'),
      'minor_child' => select_radio_button(dependent_type['child_under18']),
      'stepchild' => select_radio_button(dependent_type['step_child']),
      'adopted' => select_radio_button(dependent_type['adopted']),
      'dependent_parent' => select_radio_button(dependent_type == 'DEPENDENT_PARENT'),
      'child_incapable_self_support' => select_radio_button(dependent_type['disabled']),
      '18_23_years_old_in_school' => select_radio_button(dependent_type['child_over18_in_school'])
    }
  end
end

#merge_divorce_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1772

def merge_divorce_helpers
  divorce = @form_data['dependents_application']['report_divorce']
  return if divorce.blank?

  # extract date
  divorce['date'] = split_date(divorce['date'])

  # extract middle initial
  divorce['full_name'] = extract_middle_i(divorce, 'full_name')

  # extract country: FE uses 3 char country codes, but pdf expects 2 char country code
  divorce['location']['country'] = extract_country(divorce['location'])
end

#merge_fields(options = {}) ⇒ Object 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1539

def merge_fields(options = {})
  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
  created_at = options[:created_at] if options[:created_at].present?
  expand_signature(@form_data['veteran_information']['full_name'], created_at&.to_date || Time.zone.today)
  @form_data['signature_date'] = split_date(@form_data['signatureDate'])

  expand_remarks
  expand_veteran_ssn

  @form_data
end

#merge_previous_marriage_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1625

def merge_previous_marriage_helpers
  previous_spouses = @form_data['dependents_application']['veteran_marriage_history']
  return if previous_spouses.blank?

  previous_spouses.each do |spouse|
    # extract middle initial
    spouse['full_name'] = extract_middle_i(spouse, 'full_name')

    # extract veteran marriage history dates
    spouse['start_date'] = split_date(spouse['start_date'])
    spouse['end_date'] = split_date(spouse['end_date'])

    reason_marriage_ended = spouse['reason_marriage_ended']
    # @TODO why is annulment not an option on FE ('Annulment or other')
    spouse['reason_marriage_ended'] = {
      'death' => select_radio_button(reason_marriage_ended == 'Death'),
      'divorce' => select_radio_button(reason_marriage_ended == 'Divorce'),
      # 'annulment' => select_radio_button(reason_marriage_ended == 'ANNULMENT'),
      'other' => select_radio_button(reason_marriage_ended == 'Other')
    }

    # extract country: FE uses 3 char country codes, but pdf expects 2 char country code
    spouse['start_location']['country'] = extract_country(spouse['start_location'])
    spouse['end_location']['country'] = extract_country(spouse['end_location'])
  end
end

#merge_spouse_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1593

def merge_spouse_helpers
  spouse = @form_data['dependents_application']['spouse_information']
  return if spouse.blank?

  # extract middle initial
  spouse['full_name'] = extract_middle_i(spouse, 'full_name')

  # extract birth date
  spouse['birth_date'] = split_date(spouse['birth_date'])

  # extract ssn
  spouse['ssn'] = split_ssn(spouse['ssn'].delete('-')) if spouse['ssn'].present?

  # extract postal code and country
  if @form_data['dependents_application']['does_live_with_spouse']['address'].present?
    @form_data['dependents_application']['does_live_with_spouse']['address']['zip_code'] =
      split_postal_code(@form_data.dig('dependents_application', 'does_live_with_spouse', 'address'))
    @form_data['dependents_application']['does_live_with_spouse']['address']['country_name'] =
      extract_country(@form_data.dig('dependents_application', 'does_live_with_spouse', 'address'))
  end

  # expand is_veteran
  is_veteran = @form_data.dig('dependents_application', 'spouse_information', 'is_veteran')
  @form_data['dependents_application']['spouse_information']['is_veteran'] = {
    'is_veteran_yes' => select_radio_button(is_veteran),
    'is_veteran_no' => select_radio_button(!is_veteran)
  }

  expand_marriage_info
  expand_does_live_with_spouse
end

#merge_spouse_marriage_history_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1652

def merge_spouse_marriage_history_helpers
  previous_spouses = @form_data['dependents_application']['spouse_marriage_history']
  return if previous_spouses.blank?

  previous_spouses.each do |spouse|
    # extract middle initial
    spouse['full_name'] = extract_middle_i(spouse, 'full_name')

    # extract spouse marriage history dates
    spouse['start_date'] = split_date(spouse['start_date'])
    spouse['end_date'] = split_date(spouse['end_date'])

    # expand reason marriage ended
    reason_marriage_ended = spouse['reason_marriage_ended']
    # @TODO why is annulment not an option on FE ('Annulment or other')
    spouse['reason_marriage_ended'] = {
      'death' => select_radio_button(reason_marriage_ended == 'Death'),
      'divorce' => select_radio_button(reason_marriage_ended == 'Divorce'),
      # 'annulment' => select_radio_button(reason_marriage_ended == 'ANNULMENT'),
      'other' => select_radio_button(reason_marriage_ended == 'Other')
    }

    # extract country: FE uses 3 char country codes, but pdf expects 2 char country code
    spouse['start_location']['country'] = extract_country(spouse['start_location'])
    spouse['end_location']['country'] = extract_country(spouse['end_location'])
  end
end

#merge_stepchildren_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1786

def merge_stepchildren_helpers
  step_children = @form_data['dependents_application']['step_children']
  return if step_children.blank?

  step_children.each do |stepchild|
    # extract middle initial
    stepchild['full_name'] = extract_middle_i(stepchild, 'full_name')
    stepchild['who_does_the_stepchild_live_with'] =
      extract_middle_i(stepchild, 'who_does_the_stepchild_live_with')

    # extract step_children zip codes
    stepchild['address']['zip_code'] = split_postal_code(stepchild['address'])
    stepchild['address']['country_name'] = extract_country(stepchild['address'])

    # expand living_expenses_paid
    living_expenses_paid = stepchild['living_expenses_paid']
    stepchild['living_expenses_paid'] = {
      'more_than_half' => select_radio_button(living_expenses_paid == 'More than half'),
      'half' => select_radio_button(living_expenses_paid == 'Half'),
      'less_than_half' => select_radio_button(living_expenses_paid == 'Less than half')
    }
  end

  # @TODO we ask this on our form for each child, the pdf only has this in one place
  # expand_supporting_stepchild
end

#merge_veteran_helpers ⇒ Object (private) 



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# File 'lib/pdf_fill/forms/va686c674.rb', line 1567

def merge_veteran_helpers
  veteran_information = @form_data['veteran_information']
  veteran_contact_information = @form_data['dependents_application']['veteran_contact_information']

  # extract middle initial
  veteran_information['full_name'] = extract_middle_i(veteran_information, 'full_name')

  # extract birth date
  veteran_information['birth_date'] = split_date(veteran_information['birth_date'])

  # extract ssn
  ssn = veteran_information['ssn']
  veteran_information['ssn'] = split_ssn(ssn.delete('-')) if ssn.present?

  expand_phone_number(veteran_contact_information)

  # extract postal code and country
  zip_code = split_postal_code(veteran_contact_information['veteran_address'])
  veteran_country = extract_country(veteran_contact_information['veteran_address'])
  electronic_correspondence = select_checkbox(veteran_contact_information['electronic_correspondence'])

  veteran_contact_information['veteran_address']['zip_code'] = zip_code
  veteran_contact_information['veteran_address']['country_name'] = veteran_country
  veteran_contact_information['electronic_correspondence'] = electronic_correspondence
end