Forms and Trust Documents

Choose from the options above to display the corresponding forms. If you need additional information or have a question about a form, please contact CCT.

Note: CCT forms require Adobe Reader. If you wish to fill out the form using a computer, you must first save the form to your computer (e.g. Desktop) and then open in Adobe Reader.  See How to fill out forms using Adobe Reader for more information. Click here to download Adobe Reader.


 

CCT Advocate/Grantor Forms

  • Payment Request Form
    To be submitted with supporting documentation for each disbursement request.  Make copies of the form as needed. Keep confidential as the trust account number is to be included on this form.
  • Statement Options Form
    Change how financial information about the trust account is accessed by the Advocate.
  • Deposit Form
    To submit with a check for additional funds to be deposited in the trust.
  • Receipts Ledger
    Complete this form to submit with copies of receipts.  Please send only copies of receipts; originals of receipts are not accepted. Be sure that copies of receipts can be clearly read.
  • Mileage Form
    This should be submitted along with a Payment Request Form to request mileage reimbursement for driving the Beneficiary to medical appointments and other destinations to which transportation is necessary.
  • Benefits Update Form
    To notify CCT of any changes to public benefits the Beneficiary receives.
  • Change of Contact Information
    To change the contact information for the Beneficiary and/or Advocate (Mailing Address, Home Phone Number, Business Phone Number, Cell Phone Number, Email Address or Other Changes).
  • Change of Advocate – New Advocate
    This form must be completed by someone who would like to be added as a new Advocate.
  • Service Provider/Caregiver General Form
    A template that can be used by a Service Provider to invoice the Beneficiary for services rendered that are allowable by the trust.  This form must be (a) completed in its entirety and signed by the Service Provider and (b) submitted alongside a completed Payment Request Form signed by the Advocate.
  • Service Provider/Caregiver Weekly Form
    A template that can be used by a Service Provider to invoice the Beneficiary weekly for services rendered that are allowable by the trust.  This form must be (a) completed in its entirety and signed by the Service Provider and (b) submitted alongside a completed Payment Request Form signed by the Advocate.
  • Consent for Release of Information Form
    Submission of this form gives CCT staff permission to speak with a named individual(s) regarding the Special Needs Trust for the benefit of the named Beneficiary.  This form must be completed and signed by an Advocate for the trust.  Confidential financial information, including the balance of the trust account, will not be disclosed. Completion of this form does not give the individual authorization to submit Payment Request Forms for disbursements from the trust.
  • Needs vs. Wants
    This form gives the Beneficiary a better idea of how the money in his or her trust can be best spent. A table is also provided in the form which the Beneficiary can utilize for distinguishing between needs and wants.
  • Budget Form
    A budget will help in making decisions about how to use funds from the trust. The estimated costs for the year should be based on how long you anticipate the trust lasting.

Third-Party Pooled Special Needs Trust

  • Joinder Agreement
    Complete this legal document for enrollment in the Third-Party Pooled Special Needs Trust as outlined by the CCT Master Trust Agreement.  The Joinder Agreement needs to be completed, signed and notarized.
  • Master Trust Agreement
    The Master Trust Agreement for the Third-Party Pooled Special Needs Trust.
  • Fee Schedule
    Provides information about fees associated with the Third-Party Pooled Special Needs Trust.
  • Attorney Checklist
    Checklist to be included with the Joinder Agreement.
  • Family and Beneficiary Information
    The Grantor(s) can use this form to elaborate on the vision for the trust and to share with CCT information about the Beneficiary.
  • Amendment to the Joinder Agreement
    Complete this legal document to make changes to the Successor Beneficiaries or other information on the Joinder Agreement.  Must be completed, signed, and notarized.
  • FAQs for the Third-Party Pooled Special Needs Trust
    Includes a list of answers to frequently asked questions (General, Third-Party Pooled Special Needs Trust and Supplemental Security Income (SSI) and Medicaid Information)
  • Sample Letter for Family Members and Friends
    If you wish to share information about the existence of the Third-Party Pooled Special Needs Trusts that you have established with CCT for the benefit of your loved one, please refer to the following sample letter that provides information on how additional bequests to the trust can be made by family members and friends.

First-Party Pooled Special Needs Trust

      • Joinder Agreement
        Complete this form for enrollment into the First-Party Pooled Special Needs Trust as outlined by the Master Trust Agreement.  The Joinder Agreement needs to be completed, signed and notarized.
      • Fee Schedule
        Provides information about fees associated with the First-Party Pooled Special Needs Trust.
      • Attorney Checklist
        Checklist to be included with the Joinder Agreement.
      • Objectives for the Trust
        The Advocate can use this form to elaborate on the vision and goals for the trust and to share  information about the Beneficiary which can include special interests, likes and dislikes.
      • Master Trust Agreement
        The Master Trust Agreement for the First-Party Pooled Special Needs Trust.
      • Amendment to the Joinder Agreement
        Complete this legal document to make changes to the Successor Beneficiaries or other information on the Joinder Agreement.  Must be completed, signed and notarized.
      • FAQs for the First-Party Pooled Special Needs Trust
        Includes a list of answers to frequently asked questions (General, First-Party Pooled Special Needs Trust and Supplemental Security Income (SSI) and Medicaid Information)

Please click one of the buttons at the top to view the forms.
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