Intake Prep Worksheet
Fill out this worksheet before completing the intake form at georgiabenefitssupport.com/intake. Having this information ready will make the intake process faster and help you get the most useful response.
About the Person with the Disability
Primary diagnosis or condition
Additional diagnoses (if any)
Georgia county of residence
Living situation (home, group home, etc.)
Current Benefits
Check all that currently apply and write in the monthly amount where known.
SSI — monthly amount: $__________
SSDI — monthly amount: $__________
Georgia Medicaid — Medicaid ID: __________
Medicare (Part A / B / D)
Katie Beckett / TEFRA Medicaid
GAPP (Georgia Pediatric Program)
What I'm Trying to Figure Out
My main question or problem (be as specific as possible)
Any upcoming deadlines I'm aware of
My urgency level
Today (same-day response)
My role
Family member / caregiver
Self (person with disability)
Professional / case manager
Documents I Have Ready to Upload
Recent SSA or DFCS letter or notice
Medical records or evaluation reports
Denial letter (if appealing)
Other: __________________________________________
Ready to submit?
Head to georgiabenefitssupport.com/intake to complete the intake form. You can upload documents directly through the form (up to 5 files, 10 MB each). The more detail you provide, the more specific and useful your personalized response will be.