Representative Payee

Representative Payee

PLAN of PA serves as an Organizational Representative Payee for mentally disabled adults (18+ years of age) receiving SSI & SSD benefits from the Social Security Administration. PLAN of PA strongly suggests that an individual have a case manager to become a client as we frequently collaborate with case managers. As Representative Payee, PLAN of PA arranges for the client’s Social Security check to be deposited directly into an individual, interest-bearing checking account, assures prompt payment of bills for basic food, shelter and medical needs and then helps develop a realistic, individualized budget for any remaining funds.

We charge a small fee which is determined by Social Security plus any nominal administrative fees from our banking partners.


How do I sign up for Representative Payee services with PLAN of PA?

To begin the process of naming PLAN of PA as your designated Organizational Representative Payee you must fill out the following forms and return the original signed forms — not copies — to the PLAN of PA office:

Application for Representative Payee
SSA Form 4164 This form must be filled out naming PLAN of PA as your designated Organizational Representative Payee.

SSA Form 787 Physician’s/Medical Officer’s Statement of Patient’s Capability to Manage Benefits. (This form only needs to be filled out if you do not currently have a designated Representative Payee.)

Forms  linked here are in PDF format and can be read, printed, and saved. If you need the free Acrobat PDF Reader, you can download it from Adobe.

Please call Plan office for specific instructions on filling out the forms, to determine if they qualify. We don’t want them filling out forms & applying as we are not currently taking anyone new.

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