Home » Citizens Disability™ Privacy Policy » UCPA Opt-Out Form

UCPA Opt-Out Form

"*" indicates required fields

Name*

First Last

Address*

Street Address City State Zip Code

Phone*

If you choose to proceed without providing an email address, we may have difficulty processing your request and we will have to communicate with you about your request via postal mail. This may cause significant delays in processing your request.

Opt-out of Sale/Sharing of personal information (including for targeted advertising)

You can choose whether your information is shared with third parties (including sharing that is considered a sale under state law) or used for targeted advertising. Please note that your request will apply to future sharing and use of your personal information and will not impact any sharing or use prior to your request.

Consent*

I agree to the terms and conditions below

I do NOT agree to the terms and conditions below

By clicking "Submit" below I am providing my ESIGN signature and express written consent agreement to permit Citizens Disability, LLC to contact me at the number provided above for marketing purposes regarding Citizens Disability services, including a disability claim, benefits optimization, Medicare, and/or pharmacy services, and customer care messages, such as information and reminders regarding your disability claim. I understand that these calls and/or SMS/MMS messages include those using automated technology, AI generative voice, and prerecorded and/or artificial voice messages. I confirm that the phone number above is accurate, and I am the regular user of that phone. I also agree to Citizens Disability’s SMS Terms and Conditions and Privacy Policy. For SMS messages campaigns, text “STOP” to stop and “HELP” for help. Message frequency may vary. Msg & data rates may apply. I acknowledge that my consent is not required to obtain any good or service, and to contact Citizens Disability without providing consent I can call 833-243-2965.

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Users with disabilities (and any other users) who wish to make a data deletion request, data portability request and/or information disclosure request can also contact us by emailing us at: emailing us at: privacy@citizensdisability.com; calling us at: (888) 757-4011; or (781) 516-7715; or sending us mail to: Citizens Disability, 890 Winter Street, Suite 230, Waltham, MA 02451.

Where you make a data deletion request, data portability request and/or information disclosure request through an authorized agent, we will require that you or the authorized agent provide us with a valid written authorization executed by both parties, with the validity of such document determined by us in our reasonable, good faith discretion. Please submit such documentation to us at: privacy@citizensdisability.com; or Citizens Disability, 890 Winter Street, Suite 230, Waltham, MA 02451.

Making a verifiable consumer request does not require you to create an account with us. However, we do consider requests made through your password protected account sufficiently verified when the request relates to personal information associated with that account.

We will only use personal information in a verifiable consumer request to verify the requestor’s identity or authority to make the request.

You may only make a verifiable consumer request for access or data portability twice within a twelve (12)-month period.

For additional discussion of your privacy rights, please visit our Privacy Policy.