Trust Documents & Forms

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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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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