Adapted from National Guardianship Association worksheet.

Social Security (SS) Benefits

$_____

Social Security Disability (SSDI)

$_____

Supplemental Security Income (SSI)

$_____

Veterans Administration (VA) Disability Benefits

$_____

Pension Income

$_____

Wages

$_____

Other Sources of Income (specify) ___

$_____

TOTAL MONTHLY INCOME EXPECTED

$_____

Rent

$_____

Phone

$_____

Gas

$_____

Electric

$_____

Food

$_____

Spending

$_____

Water/Sewer

$_____

Cable/Streaming Services

$_____

Transportation

$_____

Credit Card Payments

$_____

Installment Payments

$_____

Other (specify) _____

$_____

TOTAL MONTHLY EXPENSES EXPECTED

$___