src/applications/simple-forms/21-0972/containers/ConfirmationPage.jsx
import React from 'react';
import PropTypes from 'prop-types';
import { connect, useSelector } from 'react-redux';
import { ConfirmationPageView } from '../../shared/components/ConfirmationPageView';
const content = {
headlineText: 'You’ve submitted your alternate signer certification',
nextStepsText:
'You may now sign other forms on behalf of the Veteran or non-Veteran claimant you identified in this form.',
};
const childContent = (
<>
<h2>Which benefit forms can I sign?</h2>
<p>
You may now sign other forms on behalf of the Veteran or non-Veteran
claimant you identified in this form.
</p>
<va-accordion
disable-analytics={{
value: 'false',
}}
section-heading={{
value: 'null',
}}
>
<va-accordion-item header="Accrued benefits">
<ul>
<li>
Application for Accrued Amounts Due a Deceased Beneficiary (VA Form
21P-601)
<br />
<a href="/find-forms/about-form-21p-601">
Learn more about VA Form 21P-601
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Appeals">
<ul>
<li>
Decision Review Request: Supplemental Claim (VA Form 20-0995)
<br />
<a href="/find-forms/about-form-20-0995">
Learn more about VA Form 20-0995
</a>
</li>
<li>
Decision Review Request: Higher-Level Review (VA Form 20-0996)
<br />
<a href="/find-forms/about-form-20-0996">
Learn more about VA Form 20-0996
</a>
</li>
<li>
Decision Review Request: Board Appeal (Notice of Disagreement) (VA
Form 10182)
<br />
<a href="/find-forms/about-form-10182">
Learn more about VA Form 10182
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Auto allowance">
<ul>
<li>
Application for Automobile or Other Conveyance and Adaptive
Equipment (VA Form 21-4502)
<br />
<a href="/find-forms/about-form-21-4502">
Learn more about VA Form 21-4502
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Benefits for certain children with disabilities">
<ul>
<li>
Application for Benefits for a Qualifying Veteran’s Child Born with
Disabilities (VA Form 21-0304)
<br />
<a href="/find-forms/about-form-21-0304">
Learn more about VA Form 21-0304
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Compensation">
<ul>
<li>
Application for Disability Compensation and Related Compensation
Benefits (VA Form 21-526EZ)
<br />
<a href="/find-forms/about-form-21-526ez">
Learn more about VA Form 21-526EZ
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Compensation or Pension">
<ul>
<li>
Intent to File a Claim for Compensation and/or Pension, or Survivors
Pension and/or DIC (VA Form 21-0966)
<br />
<a href="/find-forms/about-form-21-0966">
Learn more about VA Form 21-0966
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Dependents">
<ul>
<li>
Application Request to Add and/or Remove Dependents (VA Form
21-686c)
<br />
<a href="/find-forms/about-form-21-686c">
Learn more about VA Form 21-686c
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Dependent parent(s)">
<ul>
<li>
Statement of Dependency of Parent(s) (VA Form 21P-509)
<br />
<a href="/find-forms/about-form-21p-509">
Learn more about VA Form 21P-509
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Individual unemployability">
<ul>
<li>
Veteran’s Application for Increased Compensation Based on
Unemployability (VA Form 21-8940)
<br />
<a href="/find-forms/about-form-21-8940">
Learn more about VA Form 21-8940
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Pension">
<ul>
<li>
Application for Veterans Pension (VA Form 21P-527EZ)
<br />
<a href="/find-forms/about-form-21p-527ez">
Learn more about VA Form 21P-527EZ
</a>
</li>
<li>
Income and Asset Statement in Support of Claim for Pension or
Parents' Dependency and Indemnity Compensation (DIC) (VA Form
21P-0969)
<br />
<a href="/find-forms/about-form-21p-0969">
Learn more about VA Form 21P-0969
</a>
</li>
<li>
Income, Net Worth, and Employment Statement (VA Form 21P-527)
<br />
<a href="/find-forms/about-form-21p-527">
Learn more about VA Form 21P-527
</a>
</li>
<li>
Pension Claim Questionnaire for Farm Income (VA Form 21P-4165)
<br />
<a href="/find-forms/about-form-21p-4165">
Learn more about VA Form 21P-4165
</a>
</li>
<li>
Medical Expense Report (VA Form 21P-8416)
<br />
<a href="/find-forms/about-form-21p-8416">
Learn more about VA Form 21P-8416
</a>
</li>
<li>
Request for Details of Expenses (VA Form 21P-8049)
<br />
<a href="/find-forms/about-form-21p-8049">
Learn more about VA Form 21P-8049
</a>
</li>
<li>
Report of Income from Property or Business (VA Form 21P-4185)
<br />
<a href="/find-forms/about-form-21p-4185">
Learn more about VA Form 21P-4185
</a>
</li>
<li>
All forms known as Eligibility Verification Reports
<br />
<a href="/find-forms/?q=Eligibility+Verification+Reports">
Learn more about Eligibility Verification Reports
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Posttraumatic stress disorder">
<ul>
<li>
Statement in Support of Claim for Service Connection for
Posttraumatic Stress Disorder (PTSD) (VA Form 21-0781)
<br />
<a href="/find-forms/about-form-21-0781">
Learn more about VA Form 21-0781
</a>
</li>
<li>
Statement in Support of Claim for Service Connection for PTSD
Secondary to Personal Assault (VA Form 21-0781a)
<br />
<a href="/find-forms/about-form-21-0781a">
Learn more about VA Form 21-0781a
</a>
</li>
</ul>
<p>
<strong>Note:</strong> If you want to fill out these forms online,
you’ll need to go to our disability compensation form,{' '}
<a href="/find-forms/about-form-21-526ez">VA Form 21-526EZ</a>. These
forms are included within the online version of VA Form 21-526EZ.
</p>
</va-accordion-item>
<va-accordion-item header="School-age children (ages 18 to 23 and in school)">
<ul>
<li>
Request for Approval of School Attendance (VA Form 21-674)
<br />
<a href="/find-forms/about-form-21-674">
Learn more about VA Form 21-674
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Specially adapted housing or special home adaptation">
<ul>
<li>
Application in Acquiring Specially Adapted Housing or Special Home
Adaptation Grant (VA Form 26-4555)
<br />
<a href="/find-forms/about-form-26-4555">
Learn more about VA Form 26-4555
</a>
</li>
</ul>
</va-accordion-item>
<va-accordion-item header="Survivor benefits">
<ul>
<li>
Application for DIC, Survivors Pension, and/or Accrued Benefit (VA
Form 21P-534EZ)
<br />
<a href="/find-forms/about-form-21p-534ez">
Learn more about VA Form 21P-534EZ
</a>
</li>
<li>
Application for Dependency and Indemnity Compensation, Survivors
Pension, and Accrued Benefits by Surviving Spouse or Child (VA Form
21P-534)
<br />
<a href="/find-forms/about-form-21p-534">
Learn more about VA Form 21P-534
</a>
</li>
<li>
Application for Dependency and Indemnity Compensation by a Surviving
Spouse or Child - In-Service Death Only (VA Form 21P-534a)
<br />
<a href="/find-forms/about-form-21p-534a">
Learn more about VA Form 21P-534a
</a>
</li>
<li>
Application for Dependency and Indemnity Compensation by Parent(s)
(VA Form 21P-535)
<br />
<a href="/find-forms/about-form-21p-535">
Learn more about VA Form 21P-535
</a>
</li>
<li>
Application of Surviving Spouse or Child for REPS Benefits (Restored
Entitlement Program for Survivors) (VA Form 21P-8924)
<br />
<a href="/find-forms/about-form-21p-8924">
Learn more about VA Form 21P-8924
</a>
</li>
</ul>
</va-accordion-item>
</va-accordion>
<br />
</>
);
export const ConfirmationPage = () => {
const form = useSelector(state => state.form || {});
const { submission } = form;
const submitDate = submission.timestamp;
const confirmationNumber = submission.response?.confirmationNumber;
return (
<ConfirmationPageView
submitterHeader="Who submitted this form"
formType="alternate signer certification"
submitterName={form.data.preparerFullName}
submitDate={submitDate}
confirmationNumber={confirmationNumber}
content={content}
childContent={childContent}
/>
);
};
ConfirmationPage.propTypes = {
form: PropTypes.shape({
data: PropTypes.shape({
fullName: {
first: PropTypes.string,
middle: PropTypes.string,
last: PropTypes.string,
suffix: PropTypes.string,
},
}),
formId: PropTypes.string,
submission: PropTypes.shape({
timestamp: PropTypes.string,
}),
}),
name: PropTypes.string,
};
function mapStateToProps(state) {
return {
form: state.form,
};
}
export default connect(mapStateToProps)(ConfirmationPage);