No personal Information will be gathered. Do you receive Social Security benefits? Yes No Do you receive SSDI? Yes No Do you receive Medicare? Yes No Do you receive SSI? Yes No Do you have Medicaid? Yes No Do you have a Ticket to Work? Yes No Did you assign your Ticket to an Employment Network/VR? Yes No If you are a person with a disability are you currently working? Yes No If you are not working do you want to work? Yes No Are you willing to work if it means your Social Security cash benefits will be reduced or even stop if you can keep your Health Coverage? Yes No Have you talked to someone from a Work Incentive Planning Assistance program about how working will affect your Social Security and other benefits? Yes No