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 signed forms — not copies — to the PLAN of PA office: • Application for Representative Payee Services • Creating a budget for a new Representative Payee Client • Request for Funds from Checking Account • 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.) Mail completed forms to: • PLAN of PA P.O.
