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

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

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If the client has a guardian, please have the guardian complete and sign this letter authorizing this change.

OR fax to 608-846-3412

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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.

New Rep Payee Appointment

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

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