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Special Needs Trust Questionnaire

Providing for Someone With a Disability Without Putting Their Benefits at Risk

What this form is for.

A special needs trust is a way to set money aside for someone with a disability without that money counting against the needs-based public benefits they rely on, such as SSI and Medi-Cal. This questionnaire gathers what our office needs to design one for your family.

Take your time with this form. Your answers save automatically in this browser, so you can close the page and come back to it later.

How to use this form.

A * marks the answers our office needs most. Nothing on this page blocks you from submitting — if you do not know an answer, choose “Unsure,” leave it blank, and send the form anyway. A partial questionnaire is genuinely useful to us. We would much rather receive it incomplete than not receive it at all.

SECTION 1: WHO IS FILLING THIS OUT

SECTION 2: THE PERSON THE TRUST IS FOR

Throughout the rest of this form we call this person the beneficiary.

About the Social Security number.

We do need it eventually, but not necessarily today. If you would rather not type it into a web form, leave it blank and give it to us by phone. That is a perfectly normal choice and it will not slow anything down.

There is no right way to write this. Plain description is exactly what we want — what the condition is, how it affects daily life, and anything a stranger would need to know to understand the situation.

Some benefit categories depend on when a disability began, so this tells us which ones may be worth looking at.

SECTION 3: CURRENT PUBLIC BENEFITS

This is the most useful section on the form.

Which benefits the beneficiary receives shapes how the trust has to be written, so anything you can tell us here helps. It does not need to be complete or exact. Mark what you know, choose “Unsure” for the rest, and move on.

SSI — Supplemental Security Income

SSDI — Social Security Disability Insurance

Medi-Cal

Medicare

IHSS — In-Home Supportive Services

Regional Center services

Section 8 or other housing assistance

CalFresh — food benefits

SECTION 4: WHOSE MONEY IS GOING IN

This one question shapes the rest of the form.

There are two kinds of special needs trust, and which one applies depends entirely on whose money goes into it. Different rules govern each. Answer below and the form will show you the follow-up questions that fit.

If you are not sure, choose “Unsure” and you will see both sets of questions. Answer whichever ones you can. Sorting this out is part of our job, not yours.

SECTION 5: WHAT GOES INTO THE TRUST

Approximate values are fine everywhere in this section. We are trying to understand the shape of what we are working with, not audit it.

List what you can

Add a line for each item. If you would rather describe it all in one place, use the notes box at the end of this section instead.

SECTION 6: WHO WILL MANAGE THE TRUST

About choosing a trustee.

The trustee decides what the trust pays for and keeps the records. In a special needs trust that record-keeping is closer than in an ordinary trust, because distributions can affect the beneficiary's benefits. Some families name a relative, some name a professional, and some name both together. There is no single right answer, and we can talk it through.

Proposed trustee

Successor trustees

Who should take over if the first trustee cannot serve? Naming more than one, in order, saves a great deal of trouble later.

SECTION 7: CARE AND QUALITY OF LIFE

This is the section that makes the trust actually useful.

The legal machinery is the easy part. What turns a special needs trust into something that helps is knowing the person it is for — how they live, what they enjoy, who looks after them, and what you want to be true for them after you are gone. Write as much or as little as you like. There are no wrong answers here.

Where the beneficiary lives now

What should the trust pay for?

Check anything you would want available. This is a starting list, not a limit, and checking something does not commit you to it.

Families often have one particular thing in mind — a summer program they look forward to every year, keeping a car on the road, season tickets, a standing order at a favourite restaurant, continuing music lessons. If there is something like that, tell us and we will make sure the trust allows for it.

The long view

This is the hardest question on the form and the most important one. Even a partial answer helps — and “we do not know yet, that is why we are here” is a real answer that we hear often.

Siblings, cousins, longtime friends, a caregiver who has been with the family for years. These are the people a future trustee will need to know about.

Routines that matter, things that upset them, what they love, how they communicate, what a good day looks like. Some families later write this up at length as a separate letter of intent, and we can help with that. A few sentences now is a good start.

SECTION 8: WHO RECEIVES WHAT IS LEFT

Whether this section applies depends on your answer in Section 4.

If the trust is funded with money that was never the beneficiary's, the person creating it chooses who receives whatever remains at the beneficiary's death. If instead the trust is funded with the beneficiary's own money, what remains is subject to a reimbursement claim by Medi-Cal, so that choice is not freely available in the same way. If you are not sure which applies to you, answer what you can and we will sort it out together.

SECTION 9: DOCUMENTS AND ARRANGEMENTS ALREADY IN PLACE

If something already exists, we need to look at it before drafting anything new, so that the pieces work together instead of against each other.

Roughly when it was done, who prepared it, and whether you know where the original is.

SECTION 10: ANYTHING ELSE

Family circumstances, a worry that has been keeping you up, a question you want answered on the first call, a deadline you are working against. Anything at all.

SECTION 11: DOCUMENTS TO SEND US

Please do not attach documents to this form.

This questionnaire cannot receive file attachments. Email the documents below to rozsa@livingtrust-attorneys.com, or bring them to your consultation. Photographs taken with your phone are perfectly acceptable.

Before you send this.

Submitting this form does not create an attorney-client relationship. We will review what you send and contact you, but no representation begins until we confirm it with you in writing.

For that reason, please do not include anything you consider confidential until representation is confirmed in writing. If something feels too sensitive for this form, leave it blank and tell us in person or by phone instead.

Law Offices of Rozsa Gyene

3500 W. Olive Ave., Suite 300
Burbank, CA 91505
Tel 818-337-4071
rozsa@livingtrust-attorneys.com

You can submit this form with unanswered questions. We will follow up on anything we need.

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