Social Benefits Advocacy

Name *

First Name

Last Name

Phone *

(###)

###

####

It is safe to leave a voicemail at your contact number? *

Yes

No

What type of application are you seeking assistance with? *

Assured Income for the Severely Handicapped (AISH)

Canada Pension Plan disability (CPP-D)

Income Support

Other

What issue are you experiencing?

AISH Denial

AISH Commencement Appeal

Benefit Cut Off

Overpayment

AISH Eligibility

Other Appeal

Other (please specify)

Have you been denied a benefit?

Yes

No

Have you submitted an appeal?

Yes

No