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)
2012 Social Security Administration Rates (PDF 138KB)
Fee Increase Letter - Benefits Management Corp (PDF 65KB)
Fee Increase Letter - LIFE (PDF 58KB)

Representative Payee Service Forms

Advance Notification of Representative Payment (Form SSA 4164) (PDF 88KB)
Client Intake Packet (PDF 415KB)
Physician’s Statement of Patient’s Capability to Manage Benefits (Form SSA 787) (PDF 138KB)
Release of Information Authorization (PDF 126KB)
Request for Representative Payee Service (PDF 67KB)

Housing Forms

Rental Agreement, Room and Board (PDF 59KB)
Rental Agreement, Room Rental (PDF 60KB)
Rental Agreement, Parent/Child Relationship (PDF 61KB)
Stop Rent Payment (PDF 50KB)

Financial Forms

Bill Payment Request (PDF 55KB)
Budget Worksheet (PDF 54KB)
Expenditure Request (PDF 49KB)

Life Freedom Debit Card Forms

Card Holder Agreement (PDF 50KB)

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.