Required Documents & Forms

 

 

Before submitting a Representative Payeeship application, please review the required documents and forms below. ICCAP cannot fully review or process an application until the necessary information, signatures, forms, and supporting documentation have been received.

Some documents verify the consumer’s identity, benefits, insurance, housing, income, and financial needs. Other forms allow ICCAP to communicate with Social Security, medical providers, landlords, utility companies, case managers, and other authorized parties when needed.

Submitting complete documents helps prevent delays.

Documents to Gather Before Starting the Application

The online application will ask for detailed information about the consumer, their benefits, housing, income, expenses, medical coverage, support contacts, and current financial situation. Please gather as many of the following documents as possible before beginning.

Document List

  • Government-issued photo ID or state ID
  • Social Security card
  • Medical insurance card
  • Medicare card, if applicable
  • Medicaid card, if applicable
  • Birth certificate, if available
  • Current lease, room and board agreement, or housing verification
  • Proof of income or benefit information
  • Current bills, arrears notices, shut-off notices, eviction notices, or urgent financial documents, if applicable
  • Case manager, agency, landlord, facility, or emergency contact information
  • Any current Representative Payee, guardian, or legal paperwork, if applicable

Required Social Security Forms

Most Representative Payeeship applications require Social Security forms before ICCAP can move forward. These forms help verify the consumer’s situation, allow information to be released, and support the payee application process.

SSA-827 | Authorization to Disclose Information

 

The SSA-827 allows medical, educational, and other authorized records to be released as part of the Social Security process. ICCAP uses this form to help support the Representative Payee application and communicate with Social Security or other authorized entities when needed.

Note: This form must be signed and completed. Incomplete or unsigned forms may delay the application.

 
Download SSA-827

SSA-787 | Medical Source Opinion of Patient’s Capability to Manage Benefits

 

The SSA-787 is completed by a physician, psychiatric doctor, or qualified medical source. This form helps Social Security determine whether the consumer can manage or direct the management of their own benefits.

Note: This form is required for most new Representative Payee requests, including many transitions from one payee to another. If the consumer cannot see a doctor or the situation is urgent, please contact ICCAP before submitting the online application.

 
Download SSA-787

Housing & Living Arrangement Documents

ICCAP needs accurate housing information to understand the consumer’s current living situation, monthly housing cost, landlord or facility contact, and whether utilities are included.
 

Examples

  • Current Lease Agreement
  • Room & Board Agreement
  • Personal Care Home Agreement
  • Nursing Facility Information or Agreement
  • Residential Program Documentation or Agreement
  • Landlord or Facility Contact Information
  • Utility Responsibility Information or Agreement
  • Rent Arrears, Eviction Notices, or Housing-Related Urgent Notices
Submit Missing Housing Documents

Medical & Insurance Documents

Medical and insurance documents help ICCAP verify active coverage and understand benefits that may affect the consumer’s care, expenses, and eligibility.
 

Examples

  • Medical insurance card
  • Medicare card
  • Medicaid card
  • Prescription coverage information
  • Managed care information
  • Medical provider contact information, if needed
  • SSA-787 completed by the medical source
Submit Missing Medical or Insurance Documents

Income & Benefit Documents

The application will ask about the consumer’s income and benefits. Please provide accurate information about all income sources, including Social Security, SSI, SSDI, pensions, VA benefits, Black Lung benefits, wages, or other payments.

 

Examples

  •  
  • Social Security Benefit Information
  • SSI or SSDI Information
  • Pension or Retirement Benefit Information
  • VA Benefit Information
  • Black Lung Benefit Information
  • Employment or Wage Information
  • Pay Stubs
  • Benefit Award Letters
  • Information About Pending Benefits or Recent Changes

Bills, Debts, and Urgent Financial Concerns

If the consumer has unpaid bills, shut-off notices, rent arrears, eviction notices, medical debt, fines, loans, or other urgent financial obligations, please provide documentation with the application or through the tracking system.

 

Examples

 

  • Rent Arrears

  • Utility Arrears

  • Shut-Off Notices

  • Eviction Notices

  • Medical Bills

  • Insurance Premiums

  • Loan Information

  • Fines or Legal Obligations

  • Transportation-Related Bills

  • Other Urgent Financial Documents

Release of Information & Consent Forms

ICCAP may need permission to communicate with Social Security, medical providers, housing providers, utility companies, financial institutions, county assistance offices, case managers, or other support agencies. These permissions allow ICCAP to verify information and coordinate services when needed.

Examples of Authorized Contacts:

  • Social Security Administration
  • Medical Providers
  • Behavioral Health Providers
  • Housing Providers or Landlords
  • Utility Companies
  • Financial Institutions
  • County Assistance Offices
  • Managed Care Organizations
  • Case Managers or Social Service Agencies
  • Other ICCAP Programs