Apply for Benefits Assistance

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Apply for Disability Benefits Assistance

We are able to assist when applying for benefits, such as SSI/SSDI, if you are struggling with paperwork, finding necesarry information or tracking down records. Fill out the form on this page to be referred to one of our disability benefits case managers. 

There is currently a waitlist for disability benefits assistance, a case manager will contact you ASAP after completing this form. 

 

Request for Help with a Disability Claim

Request for Help with a Disability Claim

Is the Applicant between ages 17 1/2 - 65 years old? *
Does the Applicant have a medical condition (physical, mental or combination of both) that is expected to last 12 months or result in death and interferes with working? *
Is the Applicant a United States citizen or a documented, permanent resident? *
Does the Applicant have an active application with Social Security or currently in the Social Security Disability Benefits appeal process? *
Is the Applicant currently working with an attorney, or other professional, on an SSI/SSDI application? *
Does the Applicant earn less than $1180 (or $1970 with vision disability) per month? *
Has the Applicant been turned down for SSI/SSDI? *
Has the Applicant been turned down for Aid to the Needy and Disabled (AND)? *
Have you worked in the last 10 years? *
Symptoms create the limitations which are preventing your ability to work and earn $1180 per month or $1970 with a vision disability.
Please Select All Services Applicant Is Receiving
Does the Applicant have any other income or assets? *
Does the Applicant have a history of alcohol or drug abuse? *
Is the Applicant currently using any non-prescribed drugs or alcohol? *