Wage Benefit Inquiry/Submission Form

Wage Benefit Inquiry/Submission Form

Thank you for inquiring about the Program's wage benefits. To begin the process, you must submit the below documents for review. Once all documents are received, it will be submitted to the Program's Payroll Department for review and processing. Disbursements are sent out at the end of every month.
Instructions: To complete this process, you will need the following required documentation to submit in the link below:
- A copy of a Special Needs Trust Agreement
- A Completed 1099 Form
- A copy of a voided check
- A copy of the Petition and Court Order determined that the claimant was legally incapacitated and appointed the Conservator in the Circuit Court
For more information, read the below details.
- Click here to read --> Important Information About The Program's Wage Benefit
- Click here to complete --> Wage Benefit Agreement
Disclaimer: Admitted claimant's families may want to consult with an attorney of his or her choice to obtain legal advice concerning how receiving the wage benefit may impact other benefits the claimant may receive or otherwise be eligible to receive.

More importantly, admitted claimants' families may want to obtain tax advice from an appropriate professional concerning potential tax issues. They may wish for legal counsel to assist them with having the claimant adjudicated legally incapacitated, having a guardian, Conservator, or Trustee appointed, and/or having a Special Needs Trust established before they request the Program issue the wage benefit.
Disclaimer: Admitted claimant's families may want to consult with an attorney of his or her choice to obtain legal advice concerning how receiving the wage benefit may impact other benefits the claimant may receive or otherwise be eligible to receive.

More importantly, admitted claimants' families may want to obtain tax advice from an appropriate professional concerning potential tax issues. They may wish for legal counsel to assist them with having the claimant adjudicated legally incapacitated, having a guardian, c-Conservator, or Trustee appointed, and/or having a Special Needs Trust established before they request the Program issue the wage benefit.
Claimant Last Name*
Claimant First Name*
Parent/ Guardian *

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Upload your documentation below. *

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