Resources

Below are forms you will find useful when initiating a Benefits Management Corp / LIFE service or making changes to a service. Most of the documents are formatted so that you may complete them electronically and save OR download, print, and complete by hand. Once complete, you may email the documents or fax them to our office 866-606-3248

For a free version of Adobe Acrobat Reader, click Adobe logo below:

General Information

Social Security Administration Guide for Representative Payees (PDF 819KB)
2021 Social Security Administration Rates (PDF 115KB)
Fee Increase Letters (Benefits Mgmt Corp, LIFE, and Benefits Management) (PDF 124KB)

Representative Payee Service Forms

Client Intake Packet (PDF 433KB)
Client Intake Packet Alta (PDF 876KB)
Physician’s Statement of Patient’s Capability to Manage Benefits (Form SSA 787) (PDF 138KB)
Consent to Release Information (PDF 42KB)
Request for Representative Payee Service (PDF 63KB)
Advance Notification of Representative Payment (Form SSA 4164) (PDF 88KB)

Housing Forms

Rental Agreement, Room and Board (PDF 48KB)
Rental Agreement, Room Rental (PDF 45KB)
Rental Agreement, Parent/Child Relationship (PDF 60KB)
Stop Rent Payment Request (PDF 41KB)

Financial Forms

Bill Payment Request (PDF 60KB)
Budget Worksheet (PDF 42KB)
Expenditure Request (PDF 39KB)

Life Freedom Debit Card Forms

Card Holder Agreement (PDF 681KB)

Relevant Links

BMC Spotlight

Ongoing Education and Training

Our staff receives regular training from the Social Security Administration to ensure we are current with existing policies and procedures related to: eligibility, reporting responsibilities, privacy and the protection of personal information. We consistently earn high marks on Social Security Audits.

Innovation in our Communities

Benefits Management Corp / LIFE works with community leaders throughout the state to develop innovative programs that help reduce homelessness and increase financial independence for vulnerable people.

Accurate and Efficient Systems

Daily account reconciliation and ability to instantly verify activity reduce fraud and protects clients. Independent reconciliation by the bank and reviews by an independent CPA guarantee the integrity of our accounting and control systems.

866-622-3098

877-707-2933

855-498-2224