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SOCIAL SECURITY
ASSISTANCE

At IC&C, we understand that navigating the Social Security system—whether for retirement or disability benefits—can feel overwhelming. Our goal is to provide education, guidance, and referrals to trusted professionals who can assist members in pursuing their benefits.

Your Trusted Partner

Keeping You Connected

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This form is designed to help us better understand your needs and connect you with appropriate resources and qualified professionals.

All information shared on this form will remain confidential and used solely for referral, educational, or coordination purposes. Your personal data will never be shared without your written consent.

Do you expect to be out of work for at least 12 months?
Yes
No
Do you already receive Social Security benefits?
Yes
No
Is an attorney helping you with this case?
Yes
No
Are you a Veteran?
Yes
No
Are you currently under the care of a doctor?
Yes
No

 I have read and agree with Interconnecting Circles & Communities' terms of service.

Select one
Yes
No

STAY CONNECTED

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Disclaimer: Interconnecting Circles and Communities does not prepare, present, or prosecute VA claims.

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