Benefits intake form

Tell Us About Your Situation

Complete this intake form so Georgia Benefits Support can review your situation and prepare for the service you selected. Your next steps will depend on the service you choose.

How it works

Complete the form

Share the information relevant to your benefits question and selected service.

We review your intake

Your information is reviewed so your service can be prepared around your situation and questions.

Receive your selected service

Depending on the service selected, you may receive a written benefits review, document guidance, application support, or a scheduled Benefits Navigation Session.

Contact information

First name *

Last name *

Email address *

Phone number (optional)

Georgia county (optional)

Preferred contact method

EmailPhoneText

How did you hear about us? (optional)

Which service are you interested in? *

Which program(s) are you inquiring about?Select all that apply

SSI (Child)SSI (Adult)SSDIDisabled Adult Child (DAC)MedicaidCMO Medicaid / SSI + MedicaidFood Stamps / SNAPMedicareWaivers

Other:

Your situation

Please describe your situation *

What actions have you already taken? (optional)

What type of help are you looking for?Select all that apply

Explanation of how a program worksStep-by-step planHelp understanding a letterAppeal process guidance / document organizationApplication guidancePrepare for a call with SSA / Medicaid

Other:

Is there a deadline involved?

Within 24 hoursWithin 3 business daysWithin 7 daysNo immediate deadline

Selecting an urgent deadline does not guarantee same-day service. If you have an agency deadline, contact the appropriate agency directly when necessary to protect your benefits or appeal rights.

If a deadline is involved, what is the reason?(select all that apply)

Renewal deadline approaching (Medicaid / SSA / SNAP)Recertification deadline approachingReceived a denialReceived a request for more information

Upload documents for review(optional)

If you have letters, denial notices, award letters, or any other documents you'd like us to look at, you can attach them here.

Please redact Social Security numbers, bank account numbers, passwords, and other sensitive information that is not necessary for us to review your question.

Uploading a document does not begin a paid document review. Document Review is $15 per document. We will confirm your selected service and payment before completing a paid review.

Click to browse or drag & drop files here

PDF, Word, JPG, PNG — up to 10 MB each · max 5 files

Your information is kept confidential. It is used to review your situation and provide the service you selected.

Independent benefits navigation, education, and support for Georgia residents exploring public benefits and community resources.

Navigate

Home Benefits & Programs Get Support Resources About Contact

Get in Touch

[email protected]Serving Georgia residents statewide

Georgia Benefits Support is an independent benefits education, navigation, and support service for Georgia residents. We are not a government agency, law firm, medical provider, or insurance company. We do not determine eligibility or make benefit decisions; those decisions are made by the appropriate program administrator. Benefits navigation services are separate from insurance sales or insurance services.

Clarity. Compassion. Results.