OMB No. 0960-0444
2009 Survey Questions
1. Did any organization or company refer you to SSA to file for disability benefits? (Yes/No)
What type of organization referred you:
Private disability company
Public (state/local) disability program
Worker’s compensation agency
Department of Veteran’s Affairs
State/local public assistance office (TANF, food stamps, general assistance programs)
Unemployment office
Other (please specify):
2. If yes, were you required to file for Social Security disability benefits as a condition of receiving cash benefits from the referring organization?
Yes
No
Do not receive or expect to receive cash benefits from the organization that referred me.
| File Type | application/msword |
| File Title | OMB No |
| Author | 666429 |
| Last Modified By | 666429 |
| File Modified | 2009-02-19 |
| File Created | 2009-02-19 |