Press n or j to go to the next uncovered block, b, p or k for the previous block.
| 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 | 5x 73x 73x 2x | import { Link } from "react-router";
import { SEATOOL_STATUS } from "shared-types";
import {
ActionForm,
DatePicker,
FormControl,
FormField,
FormItem,
FormLabel,
FormMessage,
Input,
RequiredIndicator,
} from "@/components";
import { FAQ_TAB } from "@/consts";
import { formSchemas } from "@/formSchemas";
import { getFAQLinkForAttachments } from "../../faqLinks";
export const RenewalForm = () => {
return (
<ActionForm
schema={formSchemas["contracting-renewal"]}
title="1915(b)(4) FFS Selective Contracting Renewal Waiver Details"
breadcrumbText="1915(b)(4) FFS Selective Contracting Renewal Waiver"
fields={({ control }) => (
<>
<div className="flex flex-col">
<FormLabel className="font-semibold" htmlFor="1975b">
Waiver Authority
</FormLabel>
<span className="text-lg font-thin" id="1975b">
1915(b)
</span>
</div>
<FormField
control={control}
name="waiverNumber"
render={({ field }) => (
<FormItem>
<div className="flex gap-4">
<FormLabel className="font-semibold" data-testid="waiverid-existing-label">
Existing Waiver Number to Renew <RequiredIndicator />
</FormLabel>
</div>
<p className="text-neutral-500">
Enter the existing waiver number in the format it was approved, using a dash after
the two character state abbreviation.
</p>
<FormControl className="max-w-sm">
<Input
ref={field.ref}
value={field.value}
onChange={(e) => field.onChange(e.currentTarget.value.toUpperCase())}
/>
</FormControl>
<FormMessage />
</FormItem>
)}
/>
<FormField
control={control}
name="id"
render={({ field }) => (
<FormItem>
<div className="flex gap-4">
<FormLabel className="font-semibold" data-testid="waiverid-renewal-label">
1915(b) Waiver Renewal Number <RequiredIndicator />
</FormLabel>
<Link
to="/faq/waiver-renewal-id-format"
target={FAQ_TAB}
rel="noopener noreferrer"
className="text-blue-700 hover:underline flex items-center"
>
What is my 1915(b) Waiver Renewal Number?
</Link>
</div>
<p className="text-neutral-500">
The Waiver Number must be in the format of SS-####.R##.00 or SS-#####.R##.00. For
renewals, the {"'R##'"} starts with {" 'R01'"} and ascends.
</p>
<FormControl className="max-w-sm">
<Input
ref={field.ref}
value={field.value}
onChange={(e) => field.onChange(e.currentTarget.value.toUpperCase())}
/>
</FormControl>
<FormMessage />
</FormItem>
)}
/>
<FormField
control={control}
name="proposedEffectiveDate"
render={({ field }) => (
<FormItem className="max-w-lg">
<FormLabel
className="font-semibold block"
data-testid="proposedEffectiveDate-label"
>
Proposed Effective Date of 1915(b) Waiver Renewal <RequiredIndicator />
</FormLabel>
<FormControl className="max-w-sm">
<DatePicker
onChange={(date) => field.onChange(date.getTime())}
date={field.value ? new Date(field.value) : undefined}
dataTestId="proposedEffectiveDate"
/>
</FormControl>
<FormMessage />
</FormItem>
)}
/>
</>
)}
attachments={{
faqLink: getFAQLinkForAttachments("contracting-renewal"),
}}
defaultValues={{ id: "" }}
documentPollerArgs={{
property: "id",
documentChecker: (check) => check.recordExists && check.hasStatus(SEATOOL_STATUS.SUBMITTED),
}}
draftOptions={{ enabled: true, event: "contracting-renewal" }}
/>
);
};
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