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Trust Documents & Forms

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Special Needs Trust Program

Helpful Documents & Required Forms

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Setting up a family-funded trust

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Setting up a self-funded trust

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Using your Special Needs Trust

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Other helpful documents & forms

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Forms and documents for setting up a new Special Needs Trust

Family-funded Trusts

These are trusts set up with money from family members for someone with a disability.

  • Family-Funded Trust Basics | Download
    This 2-page PDF is a handy introduction to the basics of a trust funded by family and friends.
  • Family-Funded Master Agreement | Download
    This PDF is a copy of the agreement that makes Key Private Bank trustee for the Arc of Northern Virginia Special Needs Trusts. This is for information only.
  • Family-Funded Joinder Agreement | Download
    This PDF is used to set up a new special-needs trust funded by family members. It covers many aspects of the trust, such as:

      • Who will establish the trust and who will benefit from the trust.
      • The name of a trusted person who will work with the beneficiary day to day to use the trust.
      • How money left in a trust will be handled after the beneficiary dies.

    • Referencing Your Special Needs Trust | Download
      This one-page PDF explains how to refer to the Family-Funded Trust in estate planning, insurance, and retirement documents. It also covers check writing and the process called decanting.

     

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Self-funded trusts

These are trusts set up with money from a person with a disability to help himself or herself.

  • Self-Funded Trust Basics | Download
    This 2-page PDF is an introduction to the basics of a trust funded by someone with a disability.
  • Self-Funded Master Agreement | Download
    This PDF is a copy of the agreement that makes Key Private Bank trustee for the Arc of Northern Virginia Special Needs Trusts. This is for information only.
  • Self-Funded Joinder Agreement | Download
    This PDF can be filled out to set up a new special-needs trust funded by someone with a disability for himself or herself. It covers many aspects of the trust, such as:

    • Who will establish the trust and who will benefit from the trust.
    • The name of a trusted person who will work with the beneficiary day to day to use the trust.
    • How money left in a trust will be handled after the beneficiary dies.

     

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Self-Funded Trusts from Military Benefits

These forms apply only to people setting up a trust using military survivor benefits.

    • Military Survivor Benefits Plan–Special Needs Trust Policy | Download
      This PDF from the Defense Finance and Accounting Service explains how survivor benefits can be directed to a special-needs trust.

  • Military Survivor Benefits Plan–Attorney Certification | Download
    This sample certification letter should be filled out by an attorney who has prepared a special needs trust with The Arc of Northern Virginia.
  • Military Survivor Benefits Plan–Parent Template Letter | Download
    This sample letter can be used to direct survivor benefits to a person with a special-needs trust.

 

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Other helpful information, documents, and forms

  • List of Documents Needed to Set Up a Trust | Download
    This form is a list of all the documents needed prior to setting up a trust. You’ll need identification cards, social security numbers, health insurance details, contact information and more.
  • Trust Checklist and Disclosure Statement | Download
    This is a master list of all the documents you need to do to complete to set up a trust. It includes a list of important disclosures you need to know about your trust.
  • Payment Options Form | Download
    There are four ways to pay the trust enrollment fee. This form identifies your preferred choice of payment.
  • Accounts Statement Information Form | Download
    This form lets you say how often to send trust account statements. It allows you say whom to send them to.
  • W-9 Form | Download
    This form is used to provide information needed to properly report taxable income to IRS.
  • Key Private Bank Investment Options | Download
    This form goes over the different ways to invest money in a trust. The choices range from low risk options that protect trust money to riskier plans that aim for growth in value.
  • Enrollment Fee Disbursement Request Form | Download
    This form allows The Arc to deduct the enrollment fee out of the initial deposit into the trust.
  • Enrollment Fee ACH Payment Form | Download
    This form allows The Arc to deduct the enrollment fee from your bank account via ACH.
  • Trust Plan | Download Part A and Part B
    This document helps guide trust decisions. Part A is for listing information about the beneficiary’s family, disability, background, medical needs and other key facts.  Part B is for listing benefits programs, employment income and health insurance information. It includes a budget plan.
  • Special Needs Trust Fees | Download
    A list of fees for enrollment in a trust, monthly management, maintenance for unfunded accounts and other fees.
  • Reporting Tips for Social Security and Medicaid | Download
    This form explain to the steps to report a SNT to Social Security and Medicaid.

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Forms and documents for using the money in a Special Needs Trust

  • Depositing Funds Into Your Trust
    • Check Guidelines | Download This PDF explains how to write a check to be deposited into a special needs trust account.
    • Log onto your own personal online banking site and use Bill Pay to write a check and mail it to The Arc of Northern Virginia. Follow same instructions in the Check Guidelines form.
    • ACH Deposit Form | Download Fill out this one-page form to add money electronically via ACH to a special needs trust.
    • Electronic Wire Deposit Form | Download Fill out this one-page form to add money electronically to a special needs trust. Please note your bank may charge you a fee for wire transfer.
  • Disbursing From Your Trust Booklet | Download
    This 43-page booklet is a comprehensive guide to using trust money. It covers the disbursement request process and reasons why a request might be approved or rejected. It includes recurring payments, purchases with credit cards, the True Link credit card, and more.
  • Disbursement Request Form | Download
    Use this form to request money to be paid from a special needs trust. Here is a Disbursement Request Form filled out with sample information.
  • Recurring Disbursement Request Form | Download
    Use this form to request payments from a trust that occur more than once.
  • Monthly Budget Plan | Download
    Use this PDF to make a monthly budget and plan for future expenses.
  • Reloadable Cards

  • How to Buy a Car with Trust Money | Download
    This is a step-by-step guide to buying a vehicle using trust money. It covers special rules for approval and the ongoing need for inspections and insurance.

 

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As a 501(c)(3) nonprofit organization, The Arc of Northern Virginia relies on private support from individuals, corporations, organizations, and foundations to fund our efforts. Your generous donations help make it possible for us to provide programs, services, and advocacy so that people with IDD can live “A Life Like Yours.”

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