Social Security Disability Survey

Please take a few minutes to help build PHA's Social Security Disability resources by filling out the following survey. Please fill out only one survey per PH patient.

1. Have you ever applied for Social Security Disability Insurance (SSD)?

2. How long did it take you to get approved for SSD? (check all that apply)

3. If you were initially denied benefits, which level(s) of appeals have you gone through? (check all that apply)

4. If you sought legal representation throughout the application process, at which levels did you do so? (check all that apply)

5. Please include any additional comments below.

6. (Optional) Please provide your contact information. While PHA will always keep your personal information confidential, we may contact you with additional resources or for general follow-up in the future.

Thank you for your participation!