Contact Us How To Contact Disability Apply Send us an email at info@disability-apply.com Do You Qualify for Social Security Disability Benefits? Do you expect to be out of work for at least 12 months? YESNO Did you earn taxable income for 5 of the last 10 years? YESNO Are you currently receiving disability benefits? YESNO Have you seen a doctor within the last 12 months? YESNO Are you currently working with a disability advocate? YESNO Please be aware that SSDI and Unemployment are different. This information is for SSDI and NOT Unemployment. Accurate information is required for a free evaluation. Your data is secure and will be transmitted by SSL encryption. Do I Qualify? Contact Us Via Email One or more of your responses indicate that you may not qualify for benefits. Please email us at info@disability-apply.com for further assistance. There is NO charge for exploring your options. Your disability advocate will only get paid if you receive benefits, and even then, it will never affect your future monthly amounts. You have nothing to lose and so much to gain! Please explore our site until then by visiting the Home Page GREAT. Your answers indicate that you're a good candidate for disability benefits! We'll need to get in touch with you to complete your official application, so please fill out the contact information below. ALL FIELDS ARE REQUIRED: First Name Last Name Email Cell Phone (ex: 7135551212) Age. How old are you? State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasU.S. Virgin IslandsUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Please be aware that SSDI and Unemployment are different. This information is for SSDI and NOT Unemployment. Accurate information is required for a free evaluation. Your data is secure and will be transmitted by SSL encryption. By submitting your request, you expressly consent Disability Apply or their third party partners to contact you by phone, text messaging, automated technology and/or email using the phone number or email address that you provided so we may assist you with your request for a free case evaluation. These partners may use an automatic telephone dialing system even if the number provided is a wireless line. Being contacted is not a condition or acceptance of services of any kind. ***Please be patient. It can take up to 15 seconds to complete your submission.*** Back Get The Benefits You Deserve! N No Out-Of-Pocket Cost N File For Maximum Benefits N Significantly Increase The Chance Of Approval
