ACT Trust Forms

The Beneficiary or the Beneficiary’s authorized representative submits a Request for Disbursement form with appropriate supporting documentation to ACT via email, fax, or mail for the Beneficiary’s supplemental needs.

The Trust Administrator assigned to the account reviews each request to determine its appropriateness in light of the Trust’s terms and any benefits that the Beneficiary may be receiving.

If the request is approved, the funds from the trust account are released for payment to the vendor, service provider, or person for whom reimbursement is sought.  Please note that Social Security regulations prevent reimbursement directly to the Beneficiary under any circumstances.

Depending upon the nature of the request, the request may be paid through ACT’s business credit card.  For such requests, after the payment is authorized on ACT’s card, the funds are deducted from the Trust.

For Beneficiaries who use ACT’s restricted debit card service, cards are loaded with trust funds monthly following review of receipts for purchases made in the prior month.  Please refer to the instructions for further information regarding issuance and use of restricted debit cards.

The Beneficiary or the Beneficiary’s authorized representative may make a disbursement request.

Money distributed from a Trust account must be used for supplemental services or items for the sole benefit of the Beneficiary. Some supplemental services or items may require prior submission to the Beneficiary’s health insurance or to a government program and must be denied prior to being considered for fulfillment from a trust account. If a disbursement would disrupt a government benefit, further review may be warranted prior to granting the request.

In some cases, when it is necessary for a Trust to disburse funds for needs that are considered by Social Security to be In-Kind Support and Maintenance payments (i.e. payments for basic shelter and for food), ACT notifies the local Social Security office regarding the details of the payment.  The payment may affect the amount of benefits received in a subsequent month.

The Request for Disbursement form must be submitted with each request.  Supporting documentation must be submitted at the time the request is made.  Requests without documentation will not be fulfilled until the documentation is received. Please see the above section on Disbursement Forms for the specific form corresponding to the beneficiaries request.

Requests can be submitted to ACT at any time and there is no limit on the number of requests that can be submitted.

A Trust Administrator reviews the request and supporting documentation as soon as practicable after the request is received, often on the first business day following receipt.

Generally, it takes approximately 7 – 10 business days for a disbursement check to be issued in response to a request submitted with proper documentation, but the request may take longer if there is a need for additional documentation or there are questions regarding the distribution.

Some requests may require approval of the appropriate Court having jurisdiction of the Trust and/or approval of the Pennsylvania Department of Human Services (or if applicable, the state authority that administers the Medicaid program for the state in which the Beneficiary resides).  Requests that require Court approval may take a significantly longer time to fulfill and may require submission of additional documentation to support approval of the request.

Emergency distribution requests can be made at any time, but ACT cannot guarantee that the request will be fulfilled within a certain time frame.  Requests received during non-business hours will be reviewed at the first opportunity on the next business day.

If the amount of the item or service remains the same or consists of a bill that the Trust customarily pays for regularly (such as cable or cellular phone), there is generally no need to submit a Request form for each month that payment is requested.  A Beneficiary may contact the service provider to have the bill sent directly to ACT, but should not do so until the request has been approved by a Trust Administrator.

No, there is no limit. The entire balance of a trust account is available to pay for a supplemental service or item, but the request must be properly submitted and approved by ACT.  If a disbursement request is received that will fully deplete the Trust, ACT may require that a reserve be held in the account for payment of any final fees, including tax preparation fees, and any taxes that may be due in the current calendar year and/or the calendar year following the depletion of the trust.

On the Distribution Request Form, the Beneficiary indicates the “payee” and where to send the check. The “payee” is the person or company to whom a check is made payable. The payee should be the vendor or provider of the supplemental item or service or a third party if the request is for reimbursement of an item that has been purchased for the Beneficiary.  The check can be sent directly to the payee.  Checks cannot be made payable to the Beneficiary.  Services or items for which requests are made must be for the sole benefit of the Beneficiary.

Invoices, quotes, receipts, or statements for requested items are needed to document each expense and help safeguard eligibility for benefits. If these items are not provided, the request may be denied.

A request may be denied because additional information or documentation is needed. If this is the case, the request can be submitted again with the proper documentation.  A request may also be denied because the request exceeds the balance available in the Trust, because the request is not permissible under the terms of the Trust, because the request primarily benefits a person other than the Beneficiary, or because the request is inappropriate in light of the amount available for distribution and the beneficiary’s needs.  The Beneficiary has the right to receive an explanation from ACT as to why a request has been denied.