top of page

Forms


If you, or someone you know, would like to become a client of Support Services, please open the forms below, print them and send them to us.

Fill out all seven (7) Intake Forms which are linked below, as completely as possible. Send the other documents as well if needed.
 

  • To process your forms quickly, please mail us the originals with signatures or drop them off at our office. We also need a copy of your picture ID, and Social Security card, or award letter.

 

  • If this is the first time the client has had a payee, Social Security requires a statement from their physician stating they need a payee in order to process the forms. If the client is in need of this form, please contact our office directly.


If you have any questions please call us at 253-383-2643. We look forward to serving you.

Green Paper Structures

Intake Form

Please fill out as much of this form as you can

Paper Structures

Consent

Helps DDA/DSHS better access helpful information.

Mint Paper Structures

Release of Information

This is so we can speak to others on your behalf.

Paper Structures

Advance Notice of Rep. Payment

This lets Social Security know that you want us as your Payee

Paper Structures

Change of Address

So we can update our address with Social Security

Paper Structures

Authorization to Disclose

For Social Security

​

Torquoise Paper Structures

Authorized Representative

So we can speak to DDA/DSHS on your behalf

Blue Paper Structures

Physician's Medical Release

Please contact our office directly for this form

© 2023 by Uniting Church Arizona. Proudly created with Wix.com

bottom of page