Disability Rights Intake and Escalation Organizer

A helper should use only the information needed and respect the disabled person’s choices and lawful authority.

Describe what the record says and what you personally experience separately. Include frequency, duration, help needed, and aftereffects when relevant.

Use exact wording when you have it. You may skip this question and return later.

Use the exact date or wording from the complete document. Add the document name and page or section when you can.

Use exact wording when you have it. You may skip this question and return later.

Describe actual duties, hours, demands, changes, help, absences, or special conditions rather than relying only on a title.

State the setting, what was requested, the response, and the date. Share only the disability details needed to explain the request.

Use exact wording when you have it. You may skip this question and return later.

Use exact wording when you have it. You may skip this question and return later.

List what you need confirmed and who may be able to answer it. It is okay to write “not sure.”

Copy dates and instructions exactly from the complete notice, plan, policy, decision, or other source. Do not rely on this organizer to calculate a deadline.

Include the document name, page or line, exact quote, and anything that still needs to be checked.

List questions for an official source, benefits counselor, accredited representative, lawyer, or other qualified professional.

Write small, specific actions such as checking an official source, requesting a record, calling a benefits counselor, or finding qualified help. Verify any time limit separately.