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!

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