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Note: GovBenefits.gov cannot guarantee your eligibility for any benefit program.

GovBenefits.gov - Your Benefits Connection
 

Take Questionnaire

Complete this anonymous 5-10 minute questionnaire to obtain the most accurate list of benefit programs for which you may be eligible.

1. Date of Birth? (Enter date in mm/dd/yyyy format)
 

2. Where do you live?
  One of the 50 states or the District of Columbia
Puerto Rico, Guam, American Samoa, the Northern Mariana Islands or the U.S. Virgin Islands
Other
No Answer

3. Choose the option that best describes your citizenship status:
  U.S. Citizen
U.S. National
Non-Citizen legally admitted to the U.S
American Indian
Other
No Answer

4. What is your gender?
  Female
Male
No Answer

5. What is your race/ethnicity? (check all that apply)
  African American
Alaskan Native
Amerasian
Asian
Caucasian
Cuban
Haitian
Hispanic
Native American /American Indian
Native Hawaiian/Pacific Islander

6. Have you ever had to leave your home as a result of a disaster?
  Yes
No
No Answer

7. Are you a victim of a crime that occurred during a disaster?
  Yes
No
No Answer

8. Are you receiving any of the following? (check all that apply)
  Social Security retirement benefits
Social Security disability benefits
Supplemental Security Income (SSI) benefits
Social Security child’s benefits
Railroad retirement or disability benefits
Medicare
Social Security spouse’s or divorced spouse’s benefits
Social Security widow or widower’s benefits
Social Security parent’s benefits
I do not receive any of these benefits

9. Are you currently receiving or might be eligible to receive benefits from any of the following programs? (check all that apply)
  Veterans' disability compensation
Veterans' Group Life Insurance
Service-Disabled Veterans Insurance (S-DVI)
Vocational Rehab Training
Servicemembers' Group Life Insurance
Specially adapted housing grant
DOD tricare(formerly CHAMPUS)

10. Are you currently receiving or might be eligible to receive benefits from any of the following programs? (check all that apply)
  Food Stamps
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Temporary Assistance for Needy Families
Unemployment Benefits
Medicaid
Federal Pell Grant
A private traditional pension plan that has ended

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