ClientBio

This page only gives us information about your situation so that we can answer your questions.  You are not actually assigning your Ticket to Work until you have either mail or faxed us the required forms with your hand written signature.

Social Security offers you many incentives to work, go to school, or even start your own business. Some are new and some of the old ones have been revised.  We hope to provide you with a wide variety of choices (including the PASS Plan & Ticket to Work) to help you make an informed decision on how you are going to live your life.

FIlling out forms is a pain, but the more information and personal thoughts that you can share with us the better we can help you.

After filling out information make sure you click "submit". If there is needed information missing it will give you a list of what is missing.   Thanks!

May All Your Endeavors Prosper!

Firstname (Required):
Lastname: (Required)
Address:
Apt#:
City:
State:
Postal Code:
Email:
Phone (Required):
Best time to contact:
Date of Birth:
How did you hear from us?
Select those that pertain to your situation
I have turned my Ticket into another Ticket to Work Employment Network (EN)-Now or in the past:
I want to work and earn over $720 a month making me eligible for $500 Quarterly work incentive payments:
I want to work part time and go to school
I am only interested in school and need the Ticket Protection while in school
When did you become disabled?
Tell us about your disability
Do you use any assistive devices, such as wheelchair, braille, etc. Please list.
Which of the following are you interested in?
Working
College
Short-Term Training
Working at Home
Transportation Assistance
Tell us about the type of Work, School, and/or Short-Term Training you are interested in.
Please Select your marital status:
Spouse Related. (Please select "YES" for all that apply):
Spouse disabled:
Spouse is working:
They are willing to use part of their income to help me reach my goal:
Number in household including yourself:
Medical coverage (Please select "YES" for all that apply):
Medicare
Medcaid Title 19
Medicare AND Medicaid Title 19
Private Coverage
Have you worked in the last month?
18 Month lookback - List months earning over $720:
What are the Monthly amounts for the following types of income:
SSI Amount
SSDI Amount
If you have resources over $2000 you would need to put them into the PASS Plan to pay for PASS expenses to be eligible for a PASS Plan. Excluded resources are your home, property attached to your home, household items, and one car. Are your countable resources under $2000 or $3000 if married?
 
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