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Do you have a disability or medical condition that prevents you from working?*
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Are you currently working?
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What is your disabling condition?
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Are you receiving treatment or prescribed medication from a doctor?
- Yes
- No

Are you currently receiving Social Security Disability benefits?
- Yes
- No

Is an attorney helping you with your case?
- Yes
- No

Have you worked 5 of the last 10 years?
- Yes
- No

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