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Are you Currently Working? *:
Not currently working
Yes, I make more than $1,000/month
Yes, I make between $500 - 1,000/month
Yes, I make less than $500/month
Are you receiving medical treatment? *:
I see my family doctor for treatment
I see a specialist for treatment
I see my family doctor and specialist for treatment
I do not currently receive medical treatment
What is your age category?:
65 or older
Have you applied for benefits?:
Have you been denied?:
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