Submitting SSDI lead…
Connect2Attorney – SSDI for Advocate Rights Center
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First Name
Last Name
Email Address
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SSDI Eligibility Questions
Do you have any disabilities or conditions that have caused you to be out of work for the last 12 months?
Yes
No
Are you between 49-64 years old?
Yes
No
Are you currently working with a Disability Attorney?
Yes
No
Are you currently employed?
Yes
No
Do you expect to be out of work for the next 12 months?
Yes
No
Are you currently receiving Social Security, Social Security Disability or Supplemental Security Income?
Yes
No
Are you currently receiving medical treatment or seeing a doctor for your disability/condition?
Yes
No
Do you take prescribed medications for your disability?
Yes
No
Compliance & Tracking
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Test lead warning:
Please use
Test
as First Name and
Lead
as Last Name for test submissions. Standard names will be treated as real leads and may be contacted (TCPA compliance).