Tell Us About Your Situation
Answer a few questions about your age, work history and the medical condition keeping you from working.
You may qualify for Social Security Disability benefits. Answer a few simple questions to see if your circumstances may meet the preliminary criteria for a free case evaluation.
Prefer to speak with someone? 855-637-2019
Takes about 60 seconds • No obligation
Answer a few questions about your age, work history and the medical condition keeping you from working.
Your responses help determine whether your circumstances may fit the preliminary requirements for an evaluation.
If appropriate, a participating disability representative may contact you to discuss possible next steps.
Choose the answer that best describes your situation.
Choose the answer that best describes your current benefit status.
A condition generally must last or be expected to last at least 12 months.
This may include care from a doctor, clinic, therapist or specialist.
Complete your information to request a free, no-obligation evaluation.
The questionnaire is complete. Lead delivery must be connected before this page is used for live advertising.
911SSDI.com is operated by Channel Marketing Group under the Your Case Counts brand and provides general information and preliminary inquiry intake. Last updated: October 2, 2026. Use the service only if you agree to these Terms. It is a paid attorney advertising service, not a law firm or provider of legal advice.
Submitting information, passing screening, uploading files, or communicating with intake does not create an attorney-client relationship. Any representation is arranged separately with an independent attorney or law firm through a written agreement. Each provider independently decides whether to review or accept a matter.
We are not the Social Security Administration or another government agency and are not affiliated with or endorsed by them. This website does not file benefit applications. Eligibility and benefits are determined by the Social Security Administration; screening does not guarantee approval. Any representative relationship is arranged separately.
No review, response time, representation, compensation, or outcome is guaranteed. General information and preliminary screening can be incomplete and do not determine legal rights. Filing deadlines vary; submitting here does not file a claim, preserve a deadline, or extend a limitation period. Contact a licensed attorney promptly about deadlines.
Submitters must be at least 18 and provide accurate information for themselves or a person they are authorized to assist. A minor’s inquiry requires a parent, legal guardian, or other authorized adult. Do not upload another person’s sensitive information without authority.
Do not submit fabricated, impersonated, duplicate-for-payment, or unauthorized information. Do not interfere with the service, attempt unauthorized access, or upload harmful files. Supporting documents should be relevant to the inquiry.
The Privacy Policy describes collection, sharing, and contact choices. Review it and the disclosure beside the submission button before submitting. A checkbox does not create representation or consent to unrelated marketing.
Linked websites, law firms, and other independent providers have separate policies, terms, and responsibilities. Website content may change or become unavailable. You may use it for personal informational purposes; permission is required for commercial reuse of original site content and branding.
Revised Terms will be posted with an updated date. These Terms do not waive rights that cannot be waived under applicable law. Questions can be directed to Channel Marketing Group through Your Case Counts at yourcasecounts@gmail.com or 855-637-2019.
This policy covers inquiries submitted through 911SSDI.com, operated by Channel Marketing Group under the Your Case Counts brand. Last updated: October 2, 2026. For privacy questions and requests, contact Channel Marketing Group through Your Case Counts at yourcasecounts@gmail.com or 855-637-2019. Do not send identity documents, medical records, or detailed abuse accounts in an ordinary privacy-request email.
We receive your contact details, state or ZIP code where requested, screening answers, and other information you choose to submit. Answers may include health, injury, employment, financial, or abuse-related information. Provide only information relevant to your inquiry. Do not submit Social Security numbers, financial account details, identity images, medical records, or a child’s full name through this preliminary screening form.
Information is collected from your form entries and submissions. It is used to screen and route the inquiry, arrange follow-up, maintain inquiry records, support intake, and investigate inaccurate or fraudulent submissions. Screening is not a legal opinion or a benefit determination.
Your inquiry may be shared with participating independent attorneys or law firms and service providers involved in intake, routing, delivery, storage, or evaluation. Recipients depend on the case type, geography, and available providers; more than one recipient may be involved. These categories do not authorize unrelated marketing. Independent recipients have their own practices and agreements. Contact us to ask which recipients received your inquiry. Disability inquiries may also be reviewed by participating disability representatives.
Submission requests follow-up about your inquiry using the details you provided. You can ask the caller to stop, reply STOP to a text, or contact us by email or phone to withdraw permission for further contact. You may also contact an independent recipient directly. Submission does not authorize unrelated campaigns or automatically authorize every type of automated or prerecorded call.
Our hosting and delivery services process requests needed to display pages and submit information. Technical request data can include IP address, browser information, and the requested URL. Browser settings can restrict cookies and clear site data. Third-party services linked from this site operate under their own policies.
Inquiry information and files can remain in intake records and service-provider systems after submission. Contact us about retention, deletion, and which records are held for your inquiry. We do not promise a fixed deletion period or absolute security. Independent recipients may retain their records under their own policies and legal obligations.
Use the email or phone above to request access, correction, deletion, a copy of information, or an applicable opt-out. Describe the request and provide enough contact information to locate your inquiry. Verification or proof of authority may be needed; do not send sensitive documents until an appropriate method is arranged. Rights and exceptions depend on applicable law. You may use this same contact channel to ask about a denied request or an appeal.
This service is intended for adult submitters. A person submitting about a minor must be their parent, legal guardian, or otherwise authorized to act. Please contact us if information was submitted without authority. Limit information about children to what the preliminary screening requires.
Changes will be posted with an updated date. Check the policy before a new submission. A changed policy does not itself provide consent for a new use of a previous inquiry.