Documents & Forms
Ready to apply? Select the trust that is right for you and download the documents to get started.
How to Establish a Pooled Trust
Our team is happy to guide you through the enrollment process. Accounts are typically established in five (5) business days provided we receive all the appropriate documentation.
Please call customer service at (518) 439-8323 for assistance.
Watch the video for step-by-step instructions to establish an account.
Steps & Requirements for New Applicants
STEP 1: Complete and sign JA and have it notarized
Beneficiary or Donor must complete and sign the Joinder Agreement and have it notarized.
STEP 2: Attach supporting documentation
Missing or incomplete information may delay account approval.
Required supporting documentation vary by trust type. See applicable Information and Procedures.
STEP 3: Fund the Trust
Fund the trust with a minimum of $300 by electronic deposit or a check.
Some trust accounts require larger initial deposits. See applicable fee schedule.
STEP 4: Send to NYSARC for Approval
Email to intake@nysarc.org, fax to 518-439-2670, or mail to the address listed on the forms.
Deposit checks must be mailed directly to the bank, separately from the JA, and ONLY send checks to this address.
STEP 5: What Happens Next?
NYSARC will contact you with any questions. Once accepted, NYSARC will provide the necessary materials to manage the account. Our team will call you to review the process and explain important procedures.
It is the responsibility of the account Beneficiary or representative noted on the JA to submit trust documents to Medicaid, Social Security Administration (SSA), and/or other government agencies for approval.
Items currently required:
- Completed Joinder Agreement (signed and notarized)
- Copy of Beneficiary’s Social Security Card (for a replacement card, visit www.ssa.gov)
- Copy of Beneficiary’s Social Security Award Letter indicating benefit type and claim number (sample letter and instructions to verify benefits)
- OR documentation of Federal Pension benefits
- OR copy of SSA-1099 form (in place of SS Card and Award letter)
*NYSARC may request additional documentation for certain trust accounts. See the Information and Procedures for detailed instructions.
- Copy of Power of Attorney - if signed by agent
Note: Powers of Attorney executed before September 2010, must also provide an Affidavit of Full Force and Effect. - Copy of Guardianship Decree - if signed by legal guardian
- Copy of Court Order - if established account pursuant to a Court Order
*Is the beneficiary unable to sign? Learn who can establish a trust account.
For instructions to establish a NYSARC Unrestricted Fund account, click here.
Fund the Trust
For first party trusts, a one-time enrollment fee and the first month’s administrative fee will be deducted from your initial deposit in the month the account is established. See the current fee schedule for information about other programs.
EMAIL, FAX, OR MAIL DOCUMENTS TO:
intake@nysarc.org
fax: 518-439-2670
NYSARC Trust Services
PO Box 1531
Latham, New York 12110
Send check payment and deposit slip directly to the bank at:
NYSARC, Inc. Community Trust
PO Box 1788
Albany, New York 12201
- *Please ONLY send deposit checks to this address.
- *Please note: Check payment and enrollment package must be mailed separately.