Forms

Below is a list of AGED’s most common trust forms. While we prefer that you come in the office to discuss your trust needs, some people like to prepare their own documents, or fully review the forms before their meeting.

These documents are available in PDF format, making it easy to download and print. If you do not have a PDF reader on your computer, you may download one here: Free Adobe Reader.

Instructions

Making Deposits Into a Client’s Special Needs Trust Account

AGED d(4)(C) Pooled Trust Documents

AGED Welcome Letter

AGED Trust Required Documentation

AGED d(4)(C) Pooled Master Trust Agreement

AGED d(4)(C) Pooled Fee Agreement (Fillable)

AGED d(4)(C) Joinder Agreement (Fillable)

Disbursement Request Form (Fillable)

AGED Third Party Trust Documents

AGED Welcome Letter

AGED Signed Third Party Master Trust Agreement

AGED Third Party Fee Agreement (Fillable)

AGED Third Party Joinder (Fillable)

Disbursement Request Form (Fillable)

AGED Guardianship Benevolent Fund Documents

Guardianship Benevolent Fund Application (Fillable)

Guardianship Benevolent Fund Instructions

Guardianship Benevolent Fund Disbursement Request Form (Fillable)

Additional Documents

Below are additional documents from State & Federal agencies which you may also find useful. As these documents come from other sources, AGED does not guarantee the information outlined in these documents to be comprehensive, accurate, or current.

Federal Government – Medicaid & Other Related Documents

Trust Guidelines

Federal Trust Guidelines

State Qualified Trust Guidelines

Other Forms & Documents

Authorization to Release Medical Information

Authorization of Waiver of Confidentiality

DCF Application List of Required Documents

DCF Disability Determination Transmittal

DCF Fair Hearing Request Form

DCF ICP Supplement to Application

DCF Individual Designation of Representative