EXIT CareerSource NEFL Ticket to Work Questionnaire CareerSource NEFL Ticket to Work Question Title * 1. What is your name? OK Question Title * 2. Email Address: OK Question Title * 3. Phone number: OK Question Title * 4. Are you between the ages of 18 and 64 years old? Yes No OK Question Title * 5. Are you receiving disability benefits from the Social Security Administration? Yes No OK Question Title * 6. Do you know what type of work you would like to do? OK Question Title * 7. Do you have any concerns about going back to work? OK DONE