Contact SS Disability Assistance

Office Hours are:
Mon-Fri 9am-6pm

Phone: (770) 995-6009

Email Us

This form is currently under construction. Please Email Us.

Please fill out the following form if you are in need of representation. (Required fields are in blue) Your Contact Information

Your Name:
Primary Phone:
Cell phone/ Voicemail:
Email:
Street Address:
City:
State/Province:
Zip Code:
Date of Birth :
Education:	High School, Some College, BS, etc.
All types of jobs performed in the last 15 years:	Construction, Office, etc.
Date Last Worked:
Married:	Yes No
Spouse's Gross Monthly Income:
Number of Dependent Children (minor or disabled):
Benefits Currently Receiving:	Worker's Compensation Long-Term Disability Food Stamps TANF (Welfare)
Describe Impairments:
Do you have a supporting doctor who is telling you that you should not be working? Yes No
Have you filed an application with Social Security? Yes No If so, Date:
Have you received a denial? Yes No If so, Date:
Please note: Social Security only gives you 60 Days to appeal a denied claim. Click for more information.