RCAL's Representative Payee Service

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RCAL's Rep Payee Forms for your convenience

Forms For Landlords

Rental Agreement [Dutchess LandLord Agreement Form] [Ulster LandLord Agreement Form] - If you do not do leases, you will need to fill this out with your tenant and submit it to us.

Landlords: If you would like to receive your funds more efficiently have them Direct Deposited

Dutchess County Landlord ACH Form

Ulster County Landlord ACH Form 

Forms For Individuals

Info Sharing Form - You may assign one (only 1) additional person besides yourself to call and speak with us on your behalf.

Dutchess County Individual PNA ACH Form - Personal Needs Allowance (PNA) Direct Deposit Form

Ulster County Individual PNA ACH Form - Personal Needs Allowance (PNA) Direct Deposit Form

Dutchess County Additional Funds Request - If you would like additional funds please fill out this form. 
Note: You must have funds available. 

Ulster County Additional Funds Request - If you would like additional funds please fill out this form.  Note: You must have funds available. 

Forms for Representatives from other Agencies

Please make sure that you coordinate with the entire care team, remember only one representative can be appointed besides the individual

Info Sharing Form - You may assign one (only 1) additional person besides yourself to call and speak with us on your behalf.

Information Request form - As a curtesy this Agency to Agency form is provided to assist other Agencies working with our Individuals who need information.  Please make sure you have a consent form on file, and fill out this form.  Written Info Requests do not have to be by the designated representative.

 

Transitioning Services

Would you like to apply to have RCAL be your Representative Payee you need to fill out an application.  Please complete all sections and pages.  Please have your social worker or case manager assist you.  If you need assistance and do not have someone to help you, please call our Benefits Advisor at extension 24. 

RCAL Representative Payee Application - Please be aware that currently there is a backup at Social Security and it may take between 6 months to over a year to process.

Would you like to be your own Representative Payee or have someone else be your Representative Payee you need to call Social Security and fill out this form.

There are two options available to you to change Representative Payees:

  1. Have the prospective Representative Payee complete Form SSA-11 which can be found online or at your local Social Security office.

  2. Go to your local Social Security office with your prospective Representative Payee and ask them to assist you with making the change.  Call First for an appointment 1-877-405-6747

To Transition to paying your own bills:

  1. If you are interested in becoming your own representative payee, please discuss this with the fiscal office.  We may be able to provide you with assistance in learning the necessary skills.

  2. A medical doctor or psychiatrist needs to write a letter stating that you are capable of resuming this responsibility. 

  3. Your current representative payee must write a letter stating that you are capable of paying your own bills.  Generally, your current payee will not do this unless you have shown responsibility in paying small bills and managing small amounts of money each month.