Apply for Assistance Apply for Assistance HomeApply for Assistance HOW CAN WE HELP YOU? SelectI NEED HELP WITH AFFORDABLE HOUSINGI NEED HELP APPLYING FOR DISABILITYI NEED HELP WITH BOTHI NEED HELP FINDING MEDICAL OR COMMUNITY RESOURCESFull NameDate of BirthPhone NumberEmail AddressPreferred Method of ContactCityZIP / Postal codeHave you already applied for Social Security Disability benefits?YesNoI need help getting startedWhich benefit are you applying for?SSDISSIBothNot sureWhat stage are you currently in?Have not appliedPreparing applicationApplication submittedWaiting for decisionDeniedReconsideration/AppealHearing stageNot sureIf already applied: Approximately when did you last receive an update from Social Security?Approximate date you last workedDo you currently have doctors or medical providers treating you?YesNoDo you have access to your medical records?YesNoSome recordsNot sureHave you received a disability denial?YesNoIf Yes: Date of denial, if knownWhat best describes your current living situation?RentingLiving with family/friendsShelterHotel/motelVehicleCurrently homeless/unshelteredFacing evictionLeaving treatmentLeaving jail/incarcerationOtherHow urgent is your housing need?Immediate/EmergencyWithin 30 daysWithin 1-3 monthsPlanning aheadNumber of adults in householdNumber of children in householdApproximate monthly household incomeMain source(s) of incomePreferred city or areaNumber of bedrooms neededMaximum affordable monthly rent, if knownDo you currently have a housing voucher or housing assistance?YesNoApplied-PendingNot sureDo you need accessible housing because of a disability or mobility limitation?YesNoIf Yes: Please describe any accessibility needs.Preferred city or areaNumber of bedrooms neededMaximum affordable monthly rent, if knownDo you currently have a housing voucher or housing assistance?YesNoApplied-PendingNot sureDo you need accessible housing because of a disability or mobility limitation?YesNoIf Yes: Please describe any accessibility needs.Have you already applied for Social Security Disability benefits?YesNoI need help getting startedWhich benefit are you applying for?SSDISSIBothNot sureWhat stage are you currently in?Have not appliedPreparing applicationApplication submittedWaiting for decisionDeniedReconsideration/AppealHearing stageNot sureIf already applied: Approximately when did you last receive an update from Social Security?Please briefly describe your housing situation and what kind of help you are looking for.Please briefly describe where you are in the disability process and what assistance you need.Additional InformationSubmit