If you have become disabled and no longer unable to work, you may be eligible for Social Security Disability!

If you are no longer unable to work, and would like to have your disability or disability claim evaluated, fill out the 'FREE DISABILITY EVALUATION' form below and submit. You will receive the evaluation results along with some additional information and advice. FREE DISABILITY EVALUATION There is absolutely no obligation in filling out this form. The submission of this form does not in any way create a Representative-client relationship In order for your claim to be evaluated, this form must be filled out as completely and accurately as possible, especially the Disability and Work History information. This information is completely confidential and cannot be used for any purpose other than your evaluation. Because of HIPAA laws, Social Security regulations and NOSSCR restrictions, we are bound to keep all information confidential. Evaluation Information Name: Address: City, State, Zip: Age: Email Address: Phone Number: Marital Status: Single Married Highest Education Level: 6th grade or less 11 grade or less Highschool College What level of the Social Security program are you at? Not filed yet. Initial claim. Reconsideration. Hearing. Have you appointed a disability representative/advocate yet? Yes No Are you being treated by a Doctor, clinic or other medical facility?: Yes No Discribe your disability(s) as complete and accurate as possible. List the medications you are on. Are you presently working?: Full Time Part Time Not Working If not working, when was your last day of work: List the jobs and job titles of work that you have done in the last 15 years? When you have finished, hit send button below. The form may take a few seconds so please do not re-submit

I have been a successful, authorized Social Security Disability Representative for over 14 years and a member in good standing of both NOSSCR* and NADR** I take a limited number of claims so that I am able to provide personalized service to every client. I have a small staff to handle paperwork and research, however, I do all the phone communications with my clients and if, for some reason, a hearing is required, I travel to your city for the hearing at NO COST to you. I have handled hundreds of claims, here in Idaho, and I have been extremely successful in getting favorable decisions. The use of fax, email, phone and mail makes it unnecessary to meet with the clients before a hearing. A representative will greatly improve your chances of a favorable decision. An experienced representative would know the Social Security rules and regulations, plus the ‘Medical Listings of Impairments’ and the ‘Medical Vocational Guidelines‘. The representative can prepare the ‘Theory of the Case’ and present an argument for your disability to the Administrative Law Judge. At the hearing, the representative will also be prepared to cross-examine the Medical Expert and the Vocational Expert to make sure that your claim is accurately presented. Social Security sets the rules on what ALL representatives can charge and that is: 25% of the 'retro-active' benefits that they are able to get for you, up to a maximum fee of $6,000 whichever is less. There are NO FEES ever paid on any of your monthly benefits following the ‘Disabled’ decision date and there are NO FEES at all if the decision is unfavorable. *NOSSCR (National Organization of Social Security Claimants Representatives) **NADR (National Association of Disability Representatives) If you have questions or need information, please don't hesitate to call! Kelly Bennett Boise, Idaho (208)283-6875