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Final Eligibility Questions for @program - Let's Go!

Checking requirements in @postal_code

src
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utm_source
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laminLid
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program
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nx_clid
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msclkid
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s_aid
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gclid
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disclaimer_variable
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leadid_token
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brand
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Do you currently receive any government benefits?

FACT: The USA spends around TWO TRILLION dollars each year on programs like @program to help people like you and me!

Do you currently receive Social Security Disability benefits?

Do you expect to be out of work for at least a year due to your health?

FACT: If you are approved for SSDI benefits in 2023, you could receive up to $3,148/month to help cover your living expenses and provide financial stability.

Have you had a full-time job within the past 5 years?

Are you actively working with a disability advocate or attorney?

What describes your situation?

Are you seeing a doctor or taking prescription medication to help with your situation?

Were you injured at work?

Have you or your spouse served in the US Military? šŸ‡ŗšŸ‡ø

Do you earn less than $1,000 a month?

Have you or a loved one been injured by one of the following, within 2 years?

Have you or a loved one been exposed to any of the following:

What is your current household credit card debt amount?

What is your monthly income?

What name will you use on your @program application?

First name
Please enter your first name
Last name
Please enter your last name

What is your zip code?

Zip code
Please enter a valid zip code
Example: 90210

Unlock Over $900/Month in Benefits by Meeting Certain Age Requirements

What year were you born, @first_name?

Birth Year
Please specify a valid birth year

Where would you like your results sent, @first_name?

mail_outline
Email address
Please enter a valid email address
phone
Phone number
Please enter a valid phone number
Example: 1112223333

Calculating eligibility for benefit programs...

Where would you like your results sent, @first_name?

mail_outline
Email address
Please enter a valid email address
phone
Phone number
Please enter a valid phone number
Example: 1112223333

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