ALL PEOPLE WITH DISABILITIES – LIFELONG OR RELATED TO ILLNESS, INJURY, OR AGE - SHOULD HAVE THE MEANS TO LIVE HEALTHY AND WELL

Forms, Notices & Fees


First-Party (MARC) Trusts

Application

Prospective enrollees in the first-party trust must complete this application. 

 

Fee Schedule

This document details PLAN’s enrollment, annual, and other fees for First-Party Trusts.

 

Notice to Applicants Age 65+

This notice relates to the application of transfer of assets penalty provisions. Applicants age 65+ and their attorneys should review this notice.

 

Third-Party Trusts

Joinder Agreement (MA)

Prospective enrollees in the third-party trust must complete this document; it serves as both an application and, when fully executed, joins a person to the third-party trust.   

 

Joinder Agreement (RI)

Same as Joinder Agreement (MA), except that signatory pages are customized for RI.

 

Life Care Plan

This document, completed by the family, outlines the wishes of the donor(s) as to how s/he or they want the trust funds to be used to benefit a loved one.  

 

Fee Schedule  

This document details PLAN’s enrollment, annual, and other fees for Third-Party Trusts.

 

General

Disbursement Guidelines

Federal law requires that the funds in a Special Needs Pooled Trust be used for the sole benefit of the trust participant. This document describes allowable and prohibited expenditures and the process for accessing funds from a trust.

 

Disbursement Request Form

Participants use this form to request that PLAN disburse funds from his / her trust account for payment to a vendor or other third party.

 

 

W-9 Form

A service provider must complete this form in order to receive payment from a Special Needs Pooled Trust account.  PLAN uses the information from the form to report all payments to the IRS. For a Spanish version click here.