Forms


Below is a list of AGED’s most common trust forms. While we prefer that you come in the office to discuss your trust needs, some people like to prepare their own documents, or fully review the forms before their meeting.

Click the link to below to jump to the particular forms you are interested in.

These documents are available in PDF format, making it easy to download and print. If you do not have a PDF reader on your computer, you may download one here: Free Adobe Reader.

Instructions

Documentation Needed to Establish a Trust with AGED

Documents Needed for Medicaid Applications

Making Deposits Into a Client’s Special Needs Trust Account New Deposit Instructions effective 07/01/2017 *Please call the office to obtain deposit instructions*

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The Florida Public Guardianship Pooled Special Needs Trust

AGED has been named the Administrative Trustee for the Florida Public Guardianship Pooled Special Needs Trust. Click here to access the documents for this trust.

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AGED d(4)(C) Pooled Trust Documents

Documentation Needed to Establish an AGED Trust

AGED Welcome Letter

AGED d(4)(C) Pooled Master Trust Agreement

AGED d(4)(C) Pooled Fee Agreement (Fillable) *Updated to reflect fee increase effective January 1, 2017*

AGED d(4)(C) Joinder Agreement (Fillable)

Instructions for Completing Pooled SNT Joinder Agreement

Disbursement Request Form (Fillable)

Authorization to Disclose Information to a Third Party Individual or Firm (Fillable)

Sample Petition and Order Authorizing Guardians to Establish a Pooled Trust

Authorization for Direct Payment VIA ACH

Online Access Form

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AGED Third Party Trust Documents

Documentation Needed to Establish an AGED Trust

AGED Welcome Letter

AGED Signed Third Party Master Trust Agreement

AGED Third Party Fee Agreement (Fillable) *Updated to reflect fee increase effective January 1, 2017*

AGED Third Party Joinder Agreement (Fillable)

Disbursement Request Form (Fillable)

Authorization to Disclose Information to a Third Party Individual or Firm (Fillable)

Authorization for Direct Payment VIA ACH

Online Access Form

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AGED Group Homes and Discounted Nursing Home Medicaid Account Documents

Important Note: AGED’s Discounted Fee Agreement for Nursing Home Medicaid is for individuals in a Nursing Home placing income only and/or less than $5,000 in assets into the trust. If assets are above $5,000 please use AGED’s d(4)(C) Pooled Trust Documents.

 

Documentation Needed to Establish an AGED Trust

AGED Welcome Letter

AGED Master Trust

AGED Group Home Fee Agreement (Fillable)

AGED Discounted Fee Agreement for Nursing Home Medicaid (Fillable)

AGED Nursing Home Medicaid / Group Home Joinder Agreement (Fillable)

Disbursement Request Form (Fillable)

Authorization to Disclose Information to a Third Party Individual or Firm (Fillable)

Authorization for Direct Payment VIA ACH

Online Access Form

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AGED Guardianship Benevolent Fund Documents

Guardianship Benevolent Fund Application (Fillable)

Guardianship Benevolent Fund Instructions

Guardianship Benevolent Fund Disbursement Request Form (Fillable)

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 Additional Documents

Below are additional documents from State & Federal agencies which you may also find useful. As these documents come from other sources, AGED does not guarantee the information outlined in these documents to be comprehensive, accurate, or current.

 Federal Government – Medicaid & Other Related Documents

Trust Guidelines

Federal Trust Guidelines

State Qualified Trust Guidelines

Other Forms & Documents

AGED Medicaid Application List of Required Documents

DCF Authorization to Release Medical Information

DCF Disability Determination Transmittal

DCF Fair Hearing Request Form

DCF Individual Designation of Representative

DCF Presumptive Disability Checklist

DCF Pooled Trust for the Disabled

DCF Request for Assistance Form

DCF & SSA Regulations – Helpful Information when Applying for Medicaid

Florida Pooled Trust Review Form

Medicaid Payback Guidelines

Medicaid Cover Sheets for Application

SSI Related Program Limits *Note updates quarterly

SSI Medicaid Disability Determination

SSI-Related Programs Fact Sheet

Social Security – Five Steps of Disability

Other Helpful Documents

AGED Comprehensive PowerPoint Presentation *PDF version of our PowerPoint presentation

SRA 2011-2012 50+ Survival Guide

Why Hire an Elder Attorney?

65 Best Tips About Medicaid Planning

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Do you need additional information not located on this page? Feel free to contact us anytime with any questions you may have.

AGED’s Online System

Changes at AGED

AGED is converting to a new software system to better manage our Trust Accounts.

Click here to get updates on the changes.

Florida Public Guardianship

AGED is now the Administrative Trustee of The Florida Public Guardianship Pooled Special Needs Trust.

Click here to access forms and information about this type of trust.

Contact AGED

Phone: (407) 682-4111
Toll Free: (888) 277-1826

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