A form, where the top part is a Social Security Number field, and the bottom part is a Username field. The middle part is "If we need to get in touch with you, how do you want us to contact you?" but there are no options available under there
https://digipres.club/system/media_attachments/files/113/678/782/822/235/702/original/6fc3b03df3a41d0c.png