Please read and sign the Client Agreement document confirming you read and agree with the terms of FA becoming your rep payee

If the client has a guardian (who IS also the current payee), please have the guardian compete and sign this letter authorizing the change.

If the client does not have a guardian, please have the client complete and sign this letter authorizing the change.

If the current payee is NOT the guardian, please have the current payee complete and sign this letter authorizing the change.

If you have a client that currently has a payee but would like to change. The following steps outline the process for changing payees.

If the client has a guardian (who is NOT the current payee), please have the guardian complete and sign this letter authorizing the change

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Complete a FA New Client Enrollment Form. Make sure all applicable fields are completed.

OR fax to 608-846-3412

Mail all information to:

   Fiscal Assistance, Inc.

   124 West Holum Street
   DeForest, WI 53532

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Please complete and sign the Consent to Release Information in order for FA to obtain and/or exchange information for the purpose of planning for your well-being

Changing Rep Payees Appointment

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