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Apply for Social Security Disability in Wisconsin

SSA, Office of Disability Adjudication and Review
2501 W. Beltline Highway, Suite 305
Madison, Wisconsin 53713

Telephone: (877) 600-2854	Fax: (608) 264-5656
eFile Fax: (877) 486-2936 Use the eFile Fax number to send evidence directly to the electronic folder.

Services the following Social Security Field Offices:
WISCONSIN:
Janesville, La Crosse, Lancaster, Madison, Portage, Rhinelander, Wausau, Wisconsin Rapids

SSA, Office of Disability Adjudication and Review
Room 300W
310 West Wisconsin Avenue
Milwaukee, Wisconsin 53203

Telephone: (866) 495-0039	Fax: (414) 297-1993
eFile Fax: (877) 486-2940 Use the eFile Fax number to send evidence directly to the electronic folder.

Services the following Social Security Field Offices:
WISCONSIN:
	Appleton, Fond du Lac, Green Bay, Greenfield, Marinette, Kenosha, Manitowoc, Milwaukee (Mitchell, North, Downtown, West), Oshkosh, Racine, Sheboygan, Waukesha, West Bend
MICHIGAN:
	Escanaba, Houghton, Marquette, Ironwood, Sault St. Marie

The form below allows you to request a Free disability benefits evaluation. Complete the form below and a disability attorney will review your case and call you to let you know if you may be eligible for benefits.

Free Evaluation

Applicant's Information

First Name

Last Name

* Name:

Street Address:

* City:

* State:

* Zip Code:

* Phone:

()

* Confirm Phone Number:

()

* Email Address:

* Date of birth:

* Does applicant expect to be out of work for at least 12 months?

YesNo

* Does applicant already receive Social Security benefits?

YesNo

* Is an attorney helping applicant with this case?

YesNo

* Is applicant a Veteran?

YesNo

* Is applicant currently under the care of a doctor?

YesNo

* How many years has applicant worked in the last 10 years?

* What is the medical condition that prevents applicant from working?

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By clicking “Submit”, I hereby consent to receive autodialed and / or pre-recorded phone calls and / or SMS Messages (for which standard rates may apply), from an attorney at the telephone number(s) provided above, even if that phone number is a wireless number and even if you have previously registered that phone number on a “do not call” list. I understand that consent is not a condition of purchase.

Privacy and Security Notice: Your personal information is strictly confidential and secure.

Upon submitting this form, you will receive a phone call shortly during regular business hours. A disability attorney will give you a free evaluation of your disability claim.

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