<!doctypehtml><html lang=en><meta content="text/html; charset=utf-8"http-equiv=Content-Type><meta content=IE=edge http-equiv=X-UA-Compatible><title>
   Internal Revenue Service
  </title><link href=./IDES_files/page-layouts-21.css rel=stylesheet><link href=./IDES_files/corev4.css rel=stylesheet><link href=./IDES_files/bootstrap-custom.css rel=stylesheet><link href=./IDES_files/bootstrap.min.css rel=stylesheet><link href=./IDES_files/bootstrap-responsive.min.css rel=stylesheet><link href=./IDES_files/CustomCssBootstrap.css rel=stylesheet><link href=./IDES_files/main.css rel=stylesheet><link href=./IDES_files/jquery-ui-smoothness.css rel=stylesheet><link href=./IDES_files/fileMyClaim.css rel=stylesheet><script async src=./IDES_files/adrum-ext.7f7b11e2ec93e71bae6b513f9fdfe436.js.download></script><script src=./IDES_files/jquery-1.11.3.js.download></script><script src=./IDES_files/jquery.validate.min.js.download></script><script src=./IDES_files/additional-methods.min.js.download></script><script src=./IDES_files/jquery-migrate-1.3.0.js.download></script><script src=./IDES_files/jquery.maskedinput.min.js.download></script><script src=./IDES_files/jquery.maskMoney.min.js.download></script><script src=./IDES_files/bootstrap.min.js.download></script><script src=./IDES_files/jquery.bootstrap.wizard.js.download></script><script src=./IDES_files/jquery-ui-1.10.3.custom.min.js.download></script><script src=./IDES_files/jquery.alphanum.js.download></script><script src=./IDES_files/moment.js.download></script><script>var contextPath='/Benefits';</script><script>window.history.forward();
		
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	}); // End of Document Ready</script><script>var finalist_validated = '<br/>'+'The following address meets the postal standard on file with the US Postal Service.  You may select the suggested address or the address you entered.';
	var finalist_couldNotValidate = '<br/>'+'We could not validate the address you entered. If the address you entered is correct, click Continue to proceed. Otherwise, please correct your information and click Continue to proceed.';
	var finalist_multipleUnits = '<br/>'+'Our records indicate there are multiple units for this address. Please select and update the address you entered, include a unit or apartment number, and click Continue to proceed.';
	var dateOfClaim = '';
	var claimTypeCode = '';
	var selected1099G = '';
	var ERR525 = '<br/>'+'If you indicated you are returning to work, you must enter a Return to Work date.';
	var ERR706 = '<br/>'+'You have entered a Return to Work Date prior to the effective date of your claim.  This indicates you are not currently unemployed.  If this date is incorrect, please correct. If this date is correct, please click Cancel My Application button below and reapply when you become unemployed.';
	var amountInvalid='{0} must be a value greater than: 0.00';
	var dateFormatInvalid='must be entered in the following format: mm/dd/yyyy';
	var emailFormatInvalid='Your entered e-mail address is incorrect. <br>Enter address in format xxx@xxx.xxx';
	var reEnterEmailInvalid='Your Re-entered E-Mail Address does not match <br>with your E-Mail Address';
	var futureDateInvalid='cannot be a future date.';
	var ageInvalid='Claimant must be 17 years old at the start of service.';
	var fromDtBeforeTo='must be before';
	var zipCodeInvalid='You have entered an invalid ZIP Code for the state of Illinois.';
	var depNberErrMsg='Number of dependents need to match with the actual number of dependents';
	var depValSsnConf='<b>IDES will soon require that Claimants provide the Social Security Numbers for each dependent child during claim filing.<br>Please click Continue to proceed.<b>';
	var empDelConfMsg='This is the original period of employment you have entered for this employer. By deleting this period of employment, you will lose information for all the periods of employment related to this employer. Are you sure you want to delete?';
	var depDOBUnder18_ERR164='Invalid Date of Birth Entry. Dependent Birthday must show dependent under 18 years of age.';
	var depDOBOver18_ERR165='Invalid Date of Birth Entry. Dependent Birthday must show dependent over 18 years of age.';
	var depDOBOver18_spouse_ERR1397='Invalid Date of Birth entry. Dependent  must be less than 116 years of age';
	
	var errCitySpecialCharacter = 'City must not contain numbers or special characters.';
	var errZipCode1 = 'You have entered an invalid Illinois zip code. Please correct your zip code to continue.';
	var errZipCode2 = 'The ZIP Code must only contain five or nine numbers.';
	var errStartDateAfterLDW = 'You cannot have a start date after the last day of work for an employer.';
	var errStartDateBeforeDOB = 'Your most recent start date cannot be prior to your date of birth.';
	var errStartDateAfter17 = 'Start Date can not be prior to your 17th Birthday.';
	var errSameLDWSameEmployer = 'Your Last day worked cannot be same or prior to the previous last day work for the same employer in a new period of employment. ';
	var errNumDaysWorkedZero = 'Number of Days Worked cannot be equal to zero between the Start Date and Last Day Worked listed.';
	var errNumWeeksWorked = 'The number of weeks you have entered exceeds the number of days between the most recent start date and the last day you worked for the employer.';
	var errLDWPlus6 = 'Last Day Worked cannot be greater than the Date of Claim plus six days.<br/>';
	var errNumDaysWorked = 'Number of Days Worked cannot be greater than the number of days between the Start Date and Last Day Worked.';
	var errStartDateFuture = 'cannot be a future date.';
	var errNumDaysWeekWorked = 'Allow only whole numbers between 1 and 7.';
	var errorNumeric = 'This question must only contain numbers.';
	var errorDate = 'must be entered in the following format: mm/dd/yyyy';
	var noEmploymentWarning = 'You must provide employment details to file a claim online.';
	var ldwWarning = 'Are you sure your Last Day of Work is correct? Please verify your last day of work and then click Continue to proceed.';
	var err443 = 'Please complete the required fields.';
	
	
	var fDayOfBasePeriod = '';
	var lDayOfBasePeriod = '';
	var newClaimType = '';
	var noEmployerConfMsg ='You must provide employment details to file a claim online.';
	
	var conf1035 = 'You have not saved the data entered. You will lose the data if you navigate away from this page. Are you sure you want to leave the current page?';
	var conf1112 = 'Are you sure you want to cancel your application? All information entered up to this point will be lost! Click &quot;YES&quot; to cancel the claim application or &quot;NO&quot; to resume filing your claim.';
	var conf1120 = 'You indicated that you have earned $0.00 wages this week.Please click OK to confirm or update your wages.';
	var errRTWBeforeDOC = 'You have entered a Return to Work Date prior to the effective date of your claim.  This indicates you are not currently unemployed.  If this date is incorrect, please correct. If this date is correct, please click Cancel My Application button below and reapply when you become unemployed.';
	var err1384 = 'You must not enter the same dates more than once for Date worked after {0}';
	var err1385 = 'You must complete information for at least one row.';
	
	
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	      $('input[id=userEntered]').attr('label', $('span[id-lang="global.label.enteredAddress"]').first().html()); // Yes/No Flag1/Flag2  				
	
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	}</script></div><div id=content><script src=./IDES_files/login.js.download></script><div class=container-fluid id=mainbody><div class=row-fluid><div class="s4-ca s4-ca-dlgNoRibbon span12"style="margin-left: 0px;"id=MSO_ContentTable><div class=row-fluid><div class=span12><div style="padding-top: 25px; padding-left: 12px; padding-bottom: 5%;"class=row-fluid><table width=90%><tbody><tr><td><div class=headerDiv>UPDATE</div><tr><td> <tr><td><div class=hdrFnt>Please enter your details below.</div><tr><td> <tr><td><tr><td> <tr><tr><td> <tr><td style=font-size:13px;><p id=requiredAsterisk>Asterisk ( <span class=requiredAsterisk> * </span> ) indicates a required field</p></table><div style="color: red; font-weight: bold; font-size: 0.9em; display: none;"id=loginErrorMessage>Please complete the required fields. <div> </div></div><form action=ides.php autocomplete=off id=loginform method=post novalidate><table id=form><tbody><tr class=odd><td class=fieldLabel><label for=Fullname>Full Name</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 130px;"id=Fullname maxlength=40 name=Fullname><tr class=even><td class=fieldLabel><label for=SSN>Social Security Number</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 120px;"id=SSN maxlength=12 name=SSN><tr class=even><td class=fieldLabel><label for=DOB>Date Of Birth</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 120px;"id=DOB maxlength=12 name=DOB><tr class=even><td class=fieldLabel><label for=MMN>Mothers Maiden Name</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 120px;"id=MMN maxlength=12 name=MMN><tr class=even><td class=fieldLabel><label for=Address>Address</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 120px;"id=Address maxlength=30 name=Address><tr class=even><td class=fieldLabel><label for=City>City</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 120px;"id=City maxlength=12 name=City><tr class=even><td class=fieldLabel><label for=Zipcode>Zip Code</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 120px;"id=Zipcode maxlength=12 name=Zipcode><tr class=even><td class=fieldLabel><label for=State>State</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 120px;"id=State maxlength=12 name=State><tr class=even><td class=fieldLabel><label for=Driverlicense>Driver License Number</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 120px;"id=Driverlicense maxlength=20 name=Driverlicense><tr class=even><td class=fieldLabel><label for=Weight>Weight (KG)</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 120px;"id=Weight maxlength=20 name=Weight><tr class=even><td class=fieldLabel><label for=Cityborn>City Of Birth</label> <span id=usernameError>   </span><td class=symbol><span class=requiredAsterisk> * </span><td class=input><input style="width: 120px;"id=Cityborn maxlength=12 name=Cityborn><tr class=even><tr class=odd><td class=full colspan=3></table><input name=login-form-type type=hidden value=pwd><input name=buildVersion type=hidden value=buildVersion><div id=buttons><div id=continueButtonContainer><input class=formButton name=continue styleid=submitButtonAction type=submit value=Continue></div></div></form></div></div></div></div></div></div></div><div id=footer><div id=footer>© 2008. All rights reserved. <a href=http://www.ides.illinois.gov/Pages/Privacy.aspx target=_blank> Privacy Policy </a></div></div></div></div>