The information provided will remain confidential. Please fill out each section. Note that some sections may not be applicable to you and may remain blank. If you have any questions, please contact ACT at 610-265-4788, or firstname.lastname@example.org. You can also review our trust document resource page for more details on ACT’s Pooled Trust Master Agreement and other valuable resources.
- Provide complete information about the Beneficiary. New Trust Information Form for Pooled Trust use; New Trust Information and Joinder Form
- If applicable, mark the type of Income that the beneficiary receives.
- Identify the type of Health Insurance that the beneficiary has.
- List information about the beneficiary’s Parents. You MUST provide details of at least one parent if the beneficiary is a minor. The SSN can be helpful in the event the person may be eligible for
- If applicable, list the Rep Payee, Power of Attorney, or Court-Appointed Guardian. Please include copies of the relevant documents for our file.
- If applicable, identify the Coordinator and Other Services received by the beneficiary.
- Identify the Settlor, the person or entity that is creating the trust. Please be sure to provide the Settlor’s SSN and a copy of Driver’s License or Passport as photo identification. If the Settlor is deceased, please provide the decedent’s SSN or Estate EIN. If the trust is funded from an education settlement, provide the School’s information, to include its EIN. These numbers are required in order for ACT to obtain an EIN for the trust.
- If known, provide the name and address of the Attorney who assisted you.
- Provide information about Funding of Account.
- List the name and address of the individual(s) who will receive Account Statements. These may be sent to more than one individual. This section must have at least one person listed.
- This section must identify the name and address of one individual who will receive Tax Information for the beneficiary’s personal income tax return. This can be a paid tax preparer, the beneficiary, or a family member. Transfers into the Trust are not tax deductible. The Trustee will issue appropriate Federal and State tax forms on a yearly basis. Beneficiaries should consult with their own tax advisor regarding their personal tax returns.
- If applicable, list any prepaid Final Arrangements for the Beneficiary. If none are currently established, please contact ACT for assistance in setting up arrangements.
- Make a copy of all your documentation and agreements.
- Send in the completed forms and supporting documentation.
- Contact ACT to set up an appointment to discuss the Trust, any questions you may have and the process moving forward. 610-265-4788
- If ACT receives the Trust request a Representative from ACT will contact the Settlor or appropriate person to set up an appointment.
Carefully read through the Disclosure Statement. Date and sign the document. Send the form to ACT with other relevant documents, including Court Orders/Petitions, Wills, annuity contracts, etc. If the Settlor is a Court-appointed Guardian, he or she must sign for the Beneficiary.
The Arc Community Trust of Pennsylvania
1012 West 9th Avenue
King of Prussia, PA 19406
At the opening meeting, a Welcome Packet will be provided to the Settlor. If an initial appointment is not feasible, ACT will send the Welcome Packet to the Settlor after the Trust is opened. The packet will include letters for the Beneficiary to send to the Social Security Administration and the Department of Human Services, as well as additional forms and information to help the Beneficiary.