REGISTER

Representative Payee Intake Form

Below you will find important information on how to apply and register with us.

If you already have a payee or was told by Social Security (SSA) that a payee is needed Click the Payee application below and email the completed application to: payee@communityimpact.biz.

If you do NOT already have a payee & have NOT been told by the Social Security Administration (SSA) please complete Both the Payee Application & SSA - 787 forms below & send the completed forms via email to payee@communityimpact.biz or via Fax to (980) 449 - 3721.

If you have any additional questions, please feel free to contact our office from 9am - 5pm Monday - Friday — we are more than happy to assist.

Payee Application

SSA-787 MD Statement Form

FAQ's