See if You Qualify!

FIND OUT IF YOU ARE ELIGIBLE FOR SOCIAL SECURITY
DISABILITY (SSI/SSDI) BENEFITS!

Date of Birth

Are you currently receiving Social Security (SSI/SSDI) benefits?

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When is the last time you worked?

Is an attorney or advocate helping you with this case?

Yes No

Are you currently seeing a doctor for your conditions?

Yes No

What are your severe medical conditions?

ABFA New Jersey Steps 4 and 5 of Subquential Evaluation

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