FORMS/RESOURCES

Below are forms you will find useful when initiating a Greater Triangle Rep Payee service or making changes to a service. The documents can be downloaded or printed to complete by hand. Once completed, you may email the documents or fax them to our office 919-651-0194

---

REPRESENTATIVE PAYEE SERVICE FORMS

Client Intake Packet-Fillable Form 

Advance Notification of Representative Payment (Form SSA 4164)

Physician’s Statement(Only complete if first time having a Payee) (Form SSA 787)

---

RESOURCES

Social Security Administration                                                                  

North Carolina Housing Finance Agency

Needy Meds

Disability Rights North Carolina

NC Property Tax Relief

United Way of the Greater Triangle

Volunteers of America - Carolinas

Special Blessings Children and Adults with Disabilities

Alliance Behavioral Healthcare

Caregiver Action Network

Aging Family Services

Easter Seals

Association of Self Advocates of NC

Dave Ramsey Financial Peace 

SouthLight Healthcare

Arc of North Carolina