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amponce/Presubmit-efsr--maximal.json

Last active July 24, 2023 20:12
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Form submission FSR streamline waiver
Raw
presubmit--minimal.json
REJECTED - Started a new form and submitted submitted a minimal amount of data
{
"metadata": {
"version": 0,
"returnUrl": "/veteran-information",
"savedAt": 1690228999887,
"submission": {
"status": false,
"errorMessage": false,
"id": false,
"timestamp": 1690228999883,
"hasAttemptedSubmit": true
}
},
"formData": {
"questions": {
"hasRecreationalVehicle": false,
"hasVehicle": false,
"hasRealEstate": false,
"hasDependents": "0",
"isMarried": false,
"vetIsEmployed": false
},
"view:components": {
"view:realEstateAdditionalInfo": {},
"view:maritalStatus": {},
"view:veteranInfo": {},
"view:vaBenefitsOnFile": {},
"view:vehicleInfo": {},
"view:recVehicleInfo": {},
"view:assetInfo": {}
},
"personalData": {
"veteranFullName": {
"first": "Mark",
"last": "Webb",
"middle": "",
"suffix": "Jr."
},
"dateOfBirth": "1950-10-04",
"address": {
"livesOnMilitaryBaseInfo": {},
"country": "USA",
"street": "123 Faker Street",
"city": "Bogusville",
"state": "GA",
"postalCode": "30058"
},
"telephoneNumber": "4445551212",
"emailAddress": "test2@test1.net",
"veteranContactInformation": {
"email": "test@user.com",
"mobilePhone": {
"areaCode": "510",
"countryCode": "1",
"createdAt": "2020-06-12T16:56:37.000+00:00",
"extension": "",
"effectiveEndDate": null,
"effectiveStartDate": "2020-07-14T19:07:45.000+00:00",
"id": 146766,
"isInternational": false,
"isTextable": null,
"isTextPermitted": null,
"isTty": null,
"isVoicemailable": null,
"phoneNumber": "9224444",
"phoneType": "HOME",
"sourceDate": "2020-07-14T19:07:45.000+00:00",
"sourceSystemUser": null,
"transactionId": "92c49d39-22b2-4bd6-92b4-0b7e7c63c6a9",
"updatedAt": "2020-07-14T19:07:46.000+00:00",
"vet360Id": "1273780"
},
"address": {
"addressLine1": "1200 Park Ave",
"addressLine2": "c/o Pixar",
"addressPou": "CORRESPONDENCE",
"addressType": "DOMESTIC",
"city": "Emeryville",
"countryName": "United States",
"countryCodeIso2": "US",
"countryCodeIso3": "USA",
"countryCodeFips": null,
"countyCode": null,
"countyName": null,
"createdAt": "2020-05-30T03:57:20.000+00:00",
"effectiveEndDate": null,
"effectiveStartDate": "2020-07-10T20:10:45.000+00:00",
"id": 173917,
"province": null,
"sourceDate": "2020-07-10T20:10:45.000+00:00",
"sourceSystemUser": null,
"stateCode": "CA",
"transactionId": "7139aa82-fd06-45ea-a217-9654869924bd",
"updatedAt": "2020-07-10T20:10:46.000+00:00",
"validationKey": null,
"vet360Id": "1273780",
"zipCode": "94608",
"zipCodeSuffix": null
}
},
"employmentHistory": {
"veteran": {},
"spouse": {}
},
"spouseFullName": {}
},
"personalIdentification": {
"ssn": "4437",
"fileNumber": "4437"
},
"selectedDebts": [],
"selectedDebtsAndCopays": [
{
"id": "3fa85f64-5717-4562-b3fc-2c963f66afa6",
"pSSeqNum": 1,
"pSTotSeqNum": 1,
"pSFacilityNum": "757",
"pSFacPhoneNum": null,
"pSTotStatement": 3,
"pSStatementVal": "0000037953E",
"pSStatementDate": "05242023",
"pSStatementDateOutput": "05/24/2023",
"pSProcessDate": "12102020",
"pSProcessDateOutput": "12/10/2020",
"pHPatientLstNme": "HHUFHYULSEHU",
"pHPatientFstNme": "CDAA",
"pHPatientMidNme": "A",
"pHAddress1": "7780 RED MAPLE CT",
"pHAddress2": null,
"pHAddress3": null,
"pHCity": "HUBER HEIGHTS",
"pHState": "OH",
"pHZipCde": "45424",
"pHZipCdeOutput": "45424",
"pHCtryNme": null,
"pHAmtDue": 105.24,
"pHAmtDueOutput": "105.24  ",
"pHPrevBal": 103.21,
"pHPrevBalOutput": "103.21  ",
"pHTotCharges": 2.03,
"pHTotChargesOutput": "2.03  ",
"pHTotCredits": 0,
"pHTotCreditsOutput": ".00  ",
"pHNewBalance": 105.24,
"pHNewBalanceOutput": "105.24  ",
"pHSpecialNotes": null,
"pHroParaCdes": "0125304050556065708085",
"pHNumOfLines": 2,
"pHDfnNumber": 197750,
"pHCernerStatementNumber": 0,
"pHCernerPatientId": " ",
"pHCernerAccountNumber": " ",
"pHIcnNumber": " ",
"pHAccountNumber": 7570000000197750,
"pHLargeFontIndcator": 0,
"details": [
{
"pDDatePosted": null,
"pDDatePostedOutput": "",
"pDTransDesc": "INTEREST/ADM. CHARGE (Int:0.10 Adm:1.93 Other:0.00",
"pDTransDescOutput": "INTEREST/ADM. CHARGE (Int:0.10 Adm:1.93 Other:0.00",
"pDTransAmt": 2.03,
"pDTransAmtOutput": "2.03  ",
"pDRefNo": null
},
{
"pDDatePosted": null,
"pDDatePostedOutput": "",
"pDTransDesc": "Please refer to previous statement of rights.",
"pDTransDescOutput": "   Please refer to previous statement of rights.",
"pDTransAmt": 0,
"pDTransAmtOutput": ".00  ",
"pDRefNo": null
}
],
"station": {
"facilitYNum": "757",
"visNNum": "10",
"facilitYDesc": "CHALMERS P WYLIE VA ACC (757)",
"cyclENum": "004",
"remiTToFlag": "L",
"maiLInsertFlag": "0",
"staTAddress1": "420 N JAMES RD",
"staTAddress2": null,
"staTAddress3": null,
"city": "Columbus",
"state": "OH",
"ziPCde": "432191834",
"ziPCdeOutput": "43219-1834",
"baRCde": "*432191834203*",
"teLNumFlag": "S",
"teLNum": "1-866-812-0318",
"teLNum2": null,
"contacTInfo": null,
"dM2TelNum": null,
"contacTInfo2": null,
"toPTelNum": null,
"lbXFedexAddress1": null,
"lbXFedexAddress2": null,
"lbXFedexAddress3": null,
"lbXFedexCity": null,
"lbXFedexState": null,
"lbXFedexZipCde": null,
"lbXFedexBarCde": null,
"lbXFedexContact": null,
"lbXFedexContactTelNum": null,
"facilityName": "Chalmers P. Wylie Veterans Outpatient Clinic"
},
"debtType": "COPAY"
}
],
"debt": {
"currentAr": 0,
"debtHistory": [
{
"date": ""
}
],
"deductionCode": "",
"originalAr": 0
},
"socialSecurity": {
"spouse": {}
},
"additionalIncome": {
"spouse": {}
},
"benefits": {
"spouseBenefits": {}
},
"assets": {},
"view:combinedFinancialStatusReport": true,
"view:enhancedFinancialStatusReport": true,
"income": [
{
"veteranOrSpouse": "VETERAN"
}
],
"AGREED": true
}
}
Raw
Presubmit-efsr--maximal.json
Presubmit Object ACCEPTED - this uses efsr-maximal, I only toggled the chapters but did not modify the data in any way.
{
"questions": {
"hasRecreationalVehicle": false,
"hasVehicle": false,
"hasRealEstate": false,
"hasDependents": "0",
"spouseHasBenefits": false,
"isMarried": true,
"vetIsEmployed": false,
"spouseIsEmployed": false
},
"view:components": {
"view:realEstateAdditionalInfo": {},
"view:maritalStatus": {},
"view:veteranInfo": {},
"view:vaBenefitsOnFile": {},
"view:vehicleInfo": {},
"view:recVehicleInfo": {},
"view:assetInfo": {}
},
"personalData": {
"spouseFullName": {
"first": "Wanda",
"last": "Ronda"
},
"veteranFullName": {
"first": "Mark",
"last": "Webb",
"middle": "",
"suffix": "Jr."
},
"dateOfBirth": "1950-10-04",
"address": {
"livesOnMilitaryBaseInfo": {},
"country": "USA",
"street": "123 Faker Street",
"city": "Bogusville",
"state": "GA",
"postalCode": "30058"
},
"telephoneNumber": "4445551212",
"emailAddress": "test2@test1.net",
"veteranContactInformation": {
"email": "test@user.com",
"mobilePhone": {
"areaCode": "510",
"countryCode": "1",
"createdAt": "2020-06-12T16:56:37.000+00:00",
"extension": "",
"effectiveEndDate": null,
"effectiveStartDate": "2020-07-14T19:07:45.000+00:00",
"id": 146766,
"isInternational": false,
"isTextable": null,
"isTextPermitted": null,
"isTty": null,
"isVoicemailable": null,
"phoneNumber": "9224444",
"phoneType": "HOME",
"sourceDate": "2020-07-14T19:07:45.000+00:00",
"sourceSystemUser": null,
"transactionId": "92c49d39-22b2-4bd6-92b4-0b7e7c63c6a9",
"updatedAt": "2020-07-14T19:07:46.000+00:00",
"vet360Id": "1273780"
},
"address": {
"addressLine1": "1200 Park Ave",
"addressLine2": "c/o Pixar",
"addressPou": "CORRESPONDENCE",
"addressType": "DOMESTIC",
"city": "Emeryville",
"countryName": "United States",
"countryCodeIso2": "US",
"countryCodeIso3": "USA",
"countryCodeFips": null,
"countyCode": null,
"countyName": null,
"createdAt": "2020-05-30T03:57:20.000+00:00",
"effectiveEndDate": null,
"effectiveStartDate": "2020-07-10T20:10:45.000+00:00",
"id": 173917,
"province": null,
"sourceDate": "2020-07-10T20:10:45.000+00:00",
"sourceSystemUser": null,
"stateCode": "CA",
"transactionId": "7139aa82-fd06-45ea-a217-9654869924bd",
"updatedAt": "2020-07-10T20:10:46.000+00:00",
"validationKey": null,
"vet360Id": "1273780",
"zipCode": "94608",
"zipCodeSuffix": null
}
},
"employmentHistory": {
"veteran": {},
"spouse": {}
}
},
"personalIdentification": {
"ssn": "4437",
"fileNumber": "4437"
},
"selectedDebts": [
{
"fileNumber": "796121200",
"payeeNumber": "00",
"personEntitled": "AJHONS",
"deductionCode": "30",
"benefitType": "Comp & Pen",
"diaryCode": "080",
"diaryCodeDescription": "Referred to the Department of the Treasury",
"amountOverpaid": 0,
"amountWithheld": 0,
"originalAr": 136.24,
"currentAr": 100,
"debtHistory": [
{
"date": "02/25/2009",
"letterCode": "914",
"description": "Paid In Full - Account balance cleared via offset, not including TOP."
},
{
"date": "02/07/2009",
"letterCode": "905",
"description": "Administrative Write Off"
},
{
"date": "12/03/2008",
"letterCode": "487",
"description": "Death Case Pending Action"
}
],
"id": 0,
"debtType": "DEBT"
}
],
"selectedDebtsAndCopays": [
{
"fileNumber": "796121200",
"payeeNumber": "00",
"personEntitled": "AJHONS",
"deductionCode": "30",
"benefitType": "Comp & Pen",
"diaryCode": "080",
"diaryCodeDescription": "Referred to the Department of the Treasury",
"amountOverpaid": 0,
"amountWithheld": 0,
"originalAr": 136.24,
"currentAr": 100,
"debtHistory": [
{
"date": "02/25/2009",
"letterCode": "914",
"description": "Paid In Full - Account balance cleared via offset, not including TOP."
},
{
"date": "02/07/2009",
"letterCode": "905",
"description": "Administrative Write Off"
},
{
"date": "12/03/2008",
"letterCode": "487",
"description": "Death Case Pending Action"
}
],
"id": 0,
"debtType": "DEBT"
}
],
"debt": {
"currentAr": 0,
"debtHistory": [
{
"date": ""
}
],
"deductionCode": "",
"originalAr": 0
},
"socialSecurity": {
"spouse": {}
},
"additionalIncome": {
"spouse": {}
},
"benefits": {
"spouseBenefits": {}
},
"assets": {},
"view:combinedFinancialStatusReport": true,
"view:enhancedFinancialStatusReport": true,
"income": [
{
"veteranOrSpouse": "VETERAN"
}
],
"agreed": true,
"AGREED": true
}
Raw
submissionObj-minimal.json
REJECTED by the server before I could test transform -
{
"personalIdentification": {
"ssn": "4437",
"fileNumber": "4437",
"fsrReason": ""
},
"personalData": {
"veteranFullName": {
"first": "Mark",
"middle": "",
"last": "Webb"
},
"address": {
"addresslineOne": "1200 Park Ave",
"addresslineTwo": "c/o Pixar",
"addresslineThree": "",
"city": "Emeryville",
"stateOrProvince": "CA",
"zipOrPostalCode": "94608",
"countryName": "US"
},
"telephoneNumber": "(510) 922-4444",
"dateOfBirth": "10/04/1950",
"married": false,
"spouseFullName": {
"first": "",
"middle": "",
"last": ""
},
"agesOfOtherDependents": [],
"employmentHistory": []
},
"income": [
{
"veteranOrSpouse": "VETERAN",
"monthlyGrossSalary": "0.00",
"deductions": {
"taxes": "0.00",
"retirement": "0.00",
"socialSecurity": "0.00",
"otherDeductions": {
"name": "",
"amount": "0.00"
}
},
"totalDeductions": "0.00",
"netTakeHomePay": "0.00",
"otherIncome": {
"name": "",
"amount": "0.00"
},
"totalMonthlyNetIncome": "0.00"
},
{
"veteranOrSpouse": "SPOUSE",
"monthlyGrossSalary": "0.00",
"deductions": {
"taxes": "0.00",
"retirement": "0.00",
"socialSecurity": "0.00",
"otherDeductions": {
"name": "",
"amount": "0.00"
}
},
"totalDeductions": "0.00",
"netTakeHomePay": "0.00",
"otherIncome": {
"name": "",
"amount": "0.00"
},
"totalMonthlyNetIncome": "0.00"
}
],
"expenses": {
"rentOrMortgage": "0.00",
"food": "0.00",
"utilities": "0.00",
"otherLivingExpenses": {
"name": "",
"amount": "0.00"
},
"expensesInstallmentContractsAndOtherDebts": "0.00",
"totalMonthlyExpenses": "0.00"
},
"discretionaryIncome": {
"netMonthlyIncomeLessExpenses": "0.00",
"amountCanBePaidTowardDebt": "0.00"
},
"assets": {
"cashInBank": "0.00",
"cashOnHand": "0.00",
"usSavingsBonds": "0.00",
"stocksAndOtherBonds": "0.00",
"realEstateOwned": "0.00",
"totalAssets": "0.00"
},
"installmentContractsAndOtherDebts": [],
"totalOfInstallmentContractsAndOtherDebts": {
"originalAmount": "0.00",
"unpaidBalance": "0.00",
"amountDueMonthly": "0.00",
"amountPastDue": "0.00"
},
"additionalData": {
"bankruptcy": {}
},
"applicantCertifications": {
"veteranSignature": "Mark Webb",
"veteranDateSigned": "07/24/2023"
},
"selectedDebtsAndCopays": [
{
"id": "3fa85f64-5717-4562-b3fc-2c963f66afa6",
"pSSeqNum": "1.00",
"pSTotSeqNum": "1.00",
"pSFacilityNum": "757",
"pSFacPhoneNum": null,
"pSTotStatement": "3.00",
"pSStatementVal": "0000037953E",
"pSStatementDate": "05242023",
"pSStatementDateOutput": "05/24/2023",
"pSProcessDate": "12102020",
"pSProcessDateOutput": "12/10/2020",
"pHPatientLstNme": "HHUFHYULSEHU",
"pHPatientFstNme": "CDAA",
"pHPatientMidNme": "A",
"pHAddress1": "7780 RED MAPLE CT",
"pHAddress2": null,
"pHAddress3": null,
"pHCity": "HUBER HEIGHTS",
"pHState": "OH",
"pHZipCde": "45424",
"pHZipCdeOutput": "45424",
"pHCtryNme": null,
"pHAmtDue": "105.24",
"pHAmtDueOutput": "105.24  ",
"pHPrevBal": "103.21",
"pHPrevBalOutput": "103.21  ",
"pHTotCharges": "2.03",
"pHTotChargesOutput": "2.03  ",
"pHTotCredits": "0.00",
"pHTotCreditsOutput": ".00  ",
"pHNewBalance": "105.24",
"pHNewBalanceOutput": "105.24  ",
"pHSpecialNotes": null,
"pHroParaCdes": "0125304050556065708085",
"pHNumOfLines": "2.00",
"pHDfnNumber": "197750.00",
"pHCernerStatementNumber": "0.00",
"pHCernerPatientId": " ",
"pHCernerAccountNumber": " ",
"pHIcnNumber": " ",
"pHAccountNumber": "7570000000197750.00",
"pHLargeFontIndcator": "0.00",
"details": [
{
"pDDatePosted": null,
"pDDatePostedOutput": "",
"pDTransDesc": "INTEREST/ADM. CHARGE (Int:0.10 Adm:1.93 Other:0.00",
"pDTransDescOutput": "INTEREST/ADM. CHARGE (Int:0.10 Adm:1.93 Other:0.00",
"pDTransAmt": "2.03",
"pDTransAmtOutput": "2.03  ",
"pDRefNo": null
},
{
"pDDatePosted": null,
"pDDatePostedOutput": "",
"pDTransDesc": "Please refer to previous statement of rights.",
"pDTransDescOutput": "   Please refer to previous statement of rights.",
"pDTransAmt": "0.00",
"pDTransAmtOutput": ".00  ",
"pDRefNo": null
}
],
"station": {
"facilitYNum": "757",
"visNNum": "10",
"facilitYDesc": "CHALMERS P WYLIE VA ACC (757)",
"cyclENum": "004",
"remiTToFlag": "L",
"maiLInsertFlag": "0",
"staTAddress1": "420 N JAMES RD",
"staTAddress2": null,
"staTAddress3": null,
"city": "Columbus",
"state": "OH",
"ziPCde": "432191834",
"ziPCdeOutput": "43219-1834",
"baRCde": "*432191834203*",
"teLNumFlag": "S",
"teLNum": "1-866-812-0318",
"teLNum2": null,
"contacTInfo": null,
"dM2TelNum": null,
"contacTInfo2": null,
"toPTelNum": null,
"lbXFedexAddress1": null,
"lbXFedexAddress2": null,
"lbXFedexAddress3": null,
"lbXFedexCity": null,
"lbXFedexState": null,
"lbXFedexZipCde": null,
"lbXFedexBarCde": null,
"lbXFedexContact": null,
"lbXFedexContactTelNum": null,
"facilityName": "Chalmers P. Wylie Veterans Outpatient Clinic"
},
"debtType": "COPAY"
}
]
}
Raw
submissionObject-efsr--maximal.json
Submission Object ACCEPTED by the Server
{
"personalIdentification": {
"ssn": "4437",
"fileNumber": "4437",
"fsrReason": ""
},
"personalData": {
"veteranFullName": {
"first": "Mark",
"middle": "",
"last": "Webb"
},
"address": {
"addresslineOne": "1200 Park Ave",
"addresslineTwo": "c/o Pixar",
"addresslineThree": "",
"city": "Emeryville",
"stateOrProvince": "CA",
"zipOrPostalCode": "94608",
"countryName": "US"
},
"telephoneNumber": "(510) 922-4444",
"dateOfBirth": "10/04/1950",
"married": true,
"spouseFullName": {
"first": "Wanda",
"middle": "",
"last": "Ronda"
},
"agesOfOtherDependents": [],
"employmentHistory": []
},
"income": [
{
"veteranOrSpouse": "VETERAN",
"monthlyGrossSalary": "0.00",
"deductions": {
"taxes": "0.00",
"retirement": "0.00",
"socialSecurity": "0.00",
"otherDeductions": {
"name": "",
"amount": "0.00"
}
},
"totalDeductions": "0.00",
"netTakeHomePay": "0.00",
"otherIncome": {
"name": "",
"amount": "0.00"
},
"totalMonthlyNetIncome": "0.00"
},
{
"veteranOrSpouse": "SPOUSE",
"monthlyGrossSalary": "0.00",
"deductions": {
"taxes": "0.00",
"retirement": "0.00",
"socialSecurity": "0.00",
"otherDeductions": {
"name": "",
"amount": "0.00"
}
},
"totalDeductions": "0.00",
"netTakeHomePay": "0.00",
"otherIncome": {
"name": "",
"amount": "0.00"
},
"totalMonthlyNetIncome": "0.00"
}
],
"expenses": {
"rentOrMortgage": "0.00",
"food": "0.00",
"utilities": "0.00",
"otherLivingExpenses": {
"name": "",
"amount": "0.00"
},
"expensesInstallmentContractsAndOtherDebts": "0.00",
"totalMonthlyExpenses": "0.00"
},
"discretionaryIncome": {
"netMonthlyIncomeLessExpenses": "0.00",
"amountCanBePaidTowardDebt": "0.00"
},
"assets": {
"cashInBank": "0.00",
"cashOnHand": "0.00",
"usSavingsBonds": "0.00",
"stocksAndOtherBonds": "0.00",
"realEstateOwned": "0.00",
"totalAssets": "0.00"
},
"installmentContractsAndOtherDebts": [],
"totalOfInstallmentContractsAndOtherDebts": {
"originalAmount": "0.00",
"unpaidBalance": "0.00",
"amountDueMonthly": "0.00",
"amountPastDue": "0.00"
},
"additionalData": {
"bankruptcy": {}
},
"applicantCertifications": {
"veteranSignature": "Mark Webb",
"veteranDateSigned": "07/24/2023"
},
"selectedDebtsAndCopays": [
{
"fileNumber": "796121200",
"payeeNumber": "00",
"personEntitled": "AJHONS",
"deductionCode": "30",
"benefitType": "Comp & Pen",
"diaryCode": "080",
"diaryCodeDescription": "Referred to the Department of the Treasury",
"amountOverpaid": "0.00",
"amountWithheld": "0.00",
"originalAr": "136.24",
"currentAr": "100.00",
"debtHistory": [
{
"date": "02/25/2009",
"letterCode": "914",
"description": "Paid In Full - Account balance cleared via offset, not including TOP."
},
{
"date": "02/07/2009",
"letterCode": "905",
"description": "Administrative Write Off"
},
{
"date": "12/03/2008",
"letterCode": "487",
"description": "Death Case Pending Action"
}
],
"id": "0.00",
"debtType": "DEBT"
}
]
}
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