Please read and sign the Client Agreement document confirming you read and agree with the terms of FA becoming your rep payee
If you have a client that may need a payee you can click the tab “Who Needs a Payee” or you can find additional resource information at the SSA website. If it is determined that the client does need a payee the following steps outline the process for obtaining a payee.
Complete a FA New Client Enrollment Form. Make sure all applicable fields are completed.
OR fax to 608-846-3412
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
If the client has a guardian, please have the guardian complete and sign this letter authorizing this change.
If there is no guardian, please have the client complete and sign this letter to authorize the change.
Mail all information to:
Fiscal Assistance, Inc.
124 West Holum Street
DeForest, WI 53532
Have physician/medical officer complete and sign an SSA form 787 “Physician’s/Medical Officer’s Statement of Patient’ Ability to Manage Benefits”.