Start your Social Security Disability Evaluation Now! Our form will quickly guide you through the first steps for your Social Security Disability claim Who are you applying for* MyselfFamily Member Back Next Are you presently receiving Social Security Disability benefits?* YesNo Previous Next Have you already submitted your Social Security Disability application?* YesNo Previous Next What is the current status of your application?* I got a denial noticeI'm still waiting for a decisionI got approved for benefitsI'm not sure Previous Next What is the date of your denial?* -Month -DayYearDate Previous Next Which age group do you belong to?* 18 to 4950 to 5455 to 6566 and older Previous Next Are you currently working?* YesNo Previous Next Please confirm your current work status.* I work full-timeI work part-timeI am self-employedI am not sure how to answer Previous Next Approximately, what is your monthly income from work before taxes?* Less than $1,689 per monthOver $1,689 per month Previous Next Your current work activity may affect your eligibility for disability benefits. Based on your response, your current work activity may affect whether you qualify for Social Security Disability benefits. You may still continue if you believe your work situation needs review. Previous Next Select a date roughly around when you became disabled.* -Month -DayYearDate Previous Next Provide a description of your disability.* Previous Next Do you currently have a treating doctor?* YesNo Previous Next Please provide the name of your doctor(s) Previous Next Have you received an evaluation or treatment for your disabling condition within the last six months?* YesNo, not yetI have an appointment scheduled Previous Next We're Sorry. Since you are already receving social security disablility, we are unable to help you at this time. This evaluation is intended for individuals who are not currently receiving benefits. If you need help with an existing claim, benefit termination or another Social Security issue, please contact our office directly at 800-424-6337. Previous Next We're Sorry. Based on your age, you do not appear to meet the Social Security Administration’s eligibility requirements for assistance with a Social Security Disability Insurance (SSDI) claim. You may instead qualify for Social Security retirement benefits or another benefits program. *To qualify for Social Security Disability Insurance (SSDI), you must become eligible before reaching your Full Retirement Age. Once you reach Full Retirement Age, you are no longer eligible to receive SSDI and may instead qualify for Social Security retirement benefits.Click HERE to visit ssa.gov for information about Full Retirement Age. Previous Next We Wish We Could Help! We noticed you mentioned needing help with housing or personal stability needs. While these are incredibly important needs, our team specializes exclusively in helping people secure Social Security Disability (SSD) benefits. SSD is a federal program that provides monthly financial benefits to individuals with a disabling condition that has lasted, or is expected to last, at least 12 continuous months or is expected to result in death. Previous Next How can we reach you? Your Full Name* First NameLast Name Your email address* Confirmation Emailexample@example.com Your Phone Number* Please enter a valid phone number.Format: (000) 000-0000. State you live in* Please Select AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY If you have applied for benefits and have been denied, there are strict deadlines that may apply. Please contact us immediately at 1-800-4-BINDER (1-800-424-6337) so that we can be retained to represent you and guide you through the process. The information presented at this site is not intended to be legal advice. The submission of information at this website does not authorize Binder & Binder to represent you or act on your behalf. The SSA requires that you must retain us and sign a Form 1696, which form we can provide to you, before we can formally represent you. Submit Source Name RecordTypeId Case Origin Please Select B&B Webform Submissions Campaign Name Campaign Source Campaign Medium Should be Empty:
