RCAL's Representative Payee Service
GENERAL INFORMATION | FAQ | FORMS | CONTACT
RCAL's Rep Payee Forms for your convenience
Applications
Forms For Landlords
Rental Agreement - We can not pay Rent with out a lease or Rental Agreement in place between the Individual we are serving and the Landlord. To assist you, if you do not have an agreement that you use ihere is a simple form for you.
Information about payments for all Landlords.
All Counties Landlord Agreement Form
Landlords: If you would like to receive your funds more efficiently have them Direct Deposited
Dutchess County Landlords - ACH Form
Ulster County Landlords - ACH Form
All Other Counties 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.
Request for Information / Update Information - Would you like to know your current Budget? Do you need a copy of your Social Security Award Letter? Would you like to request a change in your rent payment, your PNA, or your Spenddown? Please use this form.
PNA ACH Form - Dutchess County Residence - Personal Needs Allowance (PNA) Direct Deposit Form
PNA ACH Form - Ulster County Residence - Personal Needs Allowance (PNA) Direct Deposit Form
PNA ACH Form - All Other Counties - Personal Needs Allowance (PNA) Direct Deposit Form
Additional Funds Request - Dutchess County - If you would like additional funds please fill out this form.
Note: You must have funds available.
Additional Funds Request - Ulster County - If you would like additional funds please fill out this form.
Note: You must have funds available.
Additional Funds Request - All Other Counites - 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.
As a courtesy, the 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 (Info Sharing Form) on file, and fill out this form. Written Info Requests do not have to be by the designated representative.
Agency to Agency Information request form Dutchess County
Agency to Agency Information request form - Ulster County
Agency to Agency Information request form - All Other Counties
Transitioning Services
RCAL is pleased to provide Representative Payee services for you. However, if at any time you would like to transition to another Representative Payee or you believe that you are capable of handling paying your own bills, this is the process to do so.
Transitioning to another Representative Payee:
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 in making the change.
Transitioning 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 can resume this responsibility.
3. Your current representative payee must write a letter stating that you can pay your 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.
If you have any questions regarding this, you may contact us at (845) 331-7039.