For Individuals Already Working with a Payee
or If Social Security has told you that you need a payee
Please review and sign the intake referral form.
Please complete and sign SSA Form 4164 Advance Notification of Representative payment (link)
Return both of these forms to our office via mail fax or email.
What happens from here?
After all needed information is provided, SSSA will submit Form SSA11: Request to be selected as Payee to the Social Security Administration. After the Social Security administration has appointed us as your payee you will be notified by mail that SSSA has requested to become your new payee. You will be given 15 days to contest the application. If you do not respond, in person, by that time, the application will be processed, and SSSA will become your new representative payee.
Once we have been appointed as your payee we ask that you
Provide us with information regarding your monthly expenses and a copy of your rental lease if applicable.
Provide us with a current mailing address where you can receive checks and correspondence (we do require that all of our clients have a mailing address)
- Contact your utility companies (water, gas, electric, telephone, cell phone, TV, medical bills) that may issue you a monthly billing statement and change the billing address so it comes directly to us.
PO Box 1466
Glendale, AZ 85301
By doing the above we can schedule timely payments beginning the first month that we receive your benefits.
If you have any questions about any section of the application process, please feel free to contact us. This can be done through email at firstname.lastname@example.org, or by telephone at 623.414.4425, Monday through Friday between the hours of 8:00 a.m. to 5:00 p.m.
Please be advised:
It can often take one month or more for the Social Security Administration to complete the process of appointing us as your payee. We ask for your patience during this period. Until we are appointed, due to privacy laws, we will be unable to obtain any information from the Social Security Administration regarding your benefits. Our staff will do our best to advocate on your behalf.