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
$___