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The Bernstein Approach
 

Social Security Disability

Step 2 of 3

Please tell us about the disabled person:

Injured person's first name: required field
Injured person's last name: required field
Address:
City:
State:
Zip:
Area code & phone number:
 - -

Home Work Mobile
Age:
Gender: Male Female
______________________________

Please tell us about the disability:
Does disabled person work now? Yes No
If no, what was last year worked?
Please describe the disability:
Did an accident or other traumatic injury cause the disability?
Yes No Unsure
Did Social Security already deny benefits?
Yes No
If yes, when was denial?

required field = Required Why?
 
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