QIT MAIL INSTRUCTIONS

The instructions for making the payment to the State of Florida are as follows:

a. a check for the total amount of benefits paid on behalf of the Grantor up to the entire balance of the Trust fund should be made payable to “ACS Recovery Services”.

b. a copy of the QIT and statements of the Trust’s account for the previous three months and current statement indicating Trust balance should be sent to ACS.

c. draft correspondence clearly identifying the Grantor by name, Social Security number and Medicaid number, indicating that the enclosed check is from an irrevocable income trust fund, and requesting a receipt of funds and release of liability.

d. items a, b, and c should be mailed to:

ACS Recovery Systems
PO Box 12188
Tallahassee, FL 32317-2188
Telephone: 877-357-3268