– – – THREE MINUTE SURVEY – – – Do you receive Social Security cash benefits? – – – – – – – – – – – – – Are you currently working or looking to get back to work? – – – – – – – – ❤️♿️❤️♿️❤️♿️❤️♿️❤️♿️❤️♿️❤️♿️❤️♿️❤️♿️❤️ Find Out If You Qualify For A FREE Disability Employment Benefits Counselor – – You Are Not Alone! – We Are Here To Help! ❤️♿️❤️♿️❤️♿️❤️
By filling out this survey you could soon be matched with a FREE disability employment benefits counselor to help navigate the working world with a disability. Your information shared throughout the survey may be shared with our partner employment network to determine participant eligibility. Learn more about us at www.willingtoworkusa.com
First Name *
Your answer
Last Name *
Your answer
State *
Your answer
City *
Your answer
Zip Code *
Your answer
Email address *
Your answer
Phone number *
If you do not have one then provide a family members or answer by saying "I do not have one."
Your answer
Is your age between 18 and 64 years? *
Do you receive monthly Social Security Disability (SSDI) cash benefits? *
If you answered YES to receiving SSDI cash benefits, approximately when did you start receiving them?
Do you receive monthly Supplemental Security Income (SSI) cash benefits? *
If you answered YES to receiving SSI cash benefits, approximately when did you start receiving them? *
Do you receive or have you received state Vocational Rehabilitation (VR) services? *
Every state has a VR program that provides services to help individuals with disabilities to prepare for, secure, regain or retain employment.
Have you ever worked with an Employment Network? *
An Employment Network matches free employment benefit counselors to individuals with disabilities that are receiving or have recently received Social Security disability cash benefits.
Please describe your medical condition and or disability *
Your answer
What is your current employment status? *
(Optional) If you are currently employed, when did you start your job?
(Optional) If you are currently employed, are you making over $1220 per month?
(Optional) Besides your current job have you worked at other jobs since you started getting your Social Security cash benefits?
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