Candidate Identifying Information:
Part A: Housing Assessment
Part B: Current Application for SSA Benefits or Pending Appeal?
Summary and Next Steps
To assess SSI/SSDI eligibility, we are looking for basic information on:
The presence of medical and/or psychiatric conditions or symptoms which would fit an SSA listing
Current treatment, or a history of treatment for conditions
Inability to work and earn SGA ($1,310 per month in 2021) due to medical and/or psychiatric conditions (not because they cannot find work or were laid off)
Impairments in functioning due to medical and/or psychiatric conditions
Once you submit this form we will contact the client within 24 hours and also provide you with an email confirming our follow-up
Thank you for referring this client to our expert Benefits Access Support service.