National Social Security Disability Assistance
Apply for social security disability or Appeal a previous decision
About SSDI Supplemental Security Income Do I Qualify? Frequently Asked Question Get a FREE Evaluation

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Get a FREE Evaluation
If you or a loved one would like to apply for Social Security disability benefits or to appeal a previous decision, complete the form below for a free, no obligation eligibility evaluation.
After submitting the form, a representative for from the Social Security Resource Center will contact you within one day to discuss your case.
Click here if you are applying for someone else.

First Name *
Last Name *
Email Address *
    
Address
Address Other
(Apartment #, Suite #, etc.)
City *
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Phone *
  
Alternate Phone
Date Of Birth
(mm/dd/yyyy)
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I need help:
Are you currently working?
Are you receiving Social Security retirement benefits?
Have you visited a doctor in the last 12 months about your condition?
 
Do you have health insurance?
 
What is your medical condition?
 
List your prescription medications: (one per line)

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