Representative Payee

The Representative Payee Program exists as an option for the people we serve with Care Management and Trust Administration contracts. In this program, PLAN of PA serves as an Organizational Representative Payee for those receiving SSI & SSD benefits from the Social Security Administration. 

As Representative Payee, PLAN of PA:

  • Arranges for the client’s Social Security income to be deposited directly into an individual, interest-bearing checking account;
  • Creates a budget to govern how the funds are to be utilized;
  • Assures prompt payment of indicated bills and disburses any agreed upon personal expense money;
  • Charges 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?


Please call the PLAN of PA office for eligibility rules and instructions before having anyone complete the forms. This program is not currently open to new applicants.


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.

Back to Services