Money Matters Action Checklists
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1 Chapter 7: Money Matters Money Matters Action Checklists The following Action Checklists are included in Chapter 7: Income Bank Accounts Social Security Benefits Veterans Benefits Public Benefits Expenses Credit and Debit Cards Lawsuits and Judgments Outstanding Loans Personal Debts Reverse Mortgage 151
2 Checklist for Family Caregivers Income The person I care for has the following sources of income: Social Security Pension Veterans Administration Retirement plan Annuity 152
3 Chapter 7: Money Matters Long-term care insurance Rental income Family Family Other 153
4 Checklist for Family Caregivers Bank Accounts The person I care for has the following checking or savings accounts at banks or credit unions: NOTE OF CAUTION: Carefully secure this banking information. Name of institution: Phone: Fax: Website: Bank routing #: ATM PIN: Online banking user ID: Online banking password: The account is In the name of Joint with right of survivorship with Agency or convenience account with Pay on death account with Monitoring account with Name of institution: Phone: Fax: Website: Bank routing #: ATM PIN: 154
5 Chapter 7: Money Matters Online banking user ID: Online banking password: The account is In the name of Joint with right of survivorship with Agency or convenience account with Pay on death account with Monitoring account with Name of institution: Phone: Fax: Website: Bank routing #: ATM PIN: Online banking user ID: Online banking password: The account is In the name of Joint with right of survivorship with Agency or convenience account with Pay on death account with Monitoring account with Name of institution: Phone: Fax: 155
6 Checklist for Family Caregivers Website: Bank routing #: ATM PIN: Online banking user ID: Online banking password: The account is In the name of Joint with right of survivorship with Agency or convenience account with Pay on death account with Monitoring account with Name of institution: Phone: Fax: Website: Bank routing #: ATM PIN: Online banking user ID: Online banking password: The account is In the name of Joint with right of survivorship with Agency or convenience account with Pay on death account with Monitoring account with 156
7 Chapter 7: Money Matters Social Security Benefits The person I care for is eligible for Social Security benefits. The person I care for receives monthly Social Security benefits. The person I care for worked in the railroad industry at any time after January 1, 1937 (which may affect the amount of Social Security received). Name on Social Security card: Social Security number: Type of Social Security benefit: (Disability, Retirement, Widow, etc.) Monthly Social Security benefit amount: $ Social Security benefit is deposited at. 157
8 Checklist for Family Caregivers Veterans Benefits The person I care for served in the U.S. military. Full present name: First Middle Last Name served under: First Middle Last Military service number (DD-214): Date entered active service: Date separated from active service: Service post-9/11: Type of discharge: Branch: Grade or rank: National Guard: Reserves: VA Medical Center: Caregiver support coordinator: Telephone: 158
9 Chapter 7: Money Matters Public Benefits The person I care for is eligible (or I will investigate eligibility) for the following public benefits: Earned income tax credit: Reduced taxes for low-income workers ( -qualify-for-eitc) Food benefits (SNAP): Help with grocery costs ( Lifeline: Help with cost of telephone services ( /lifeline-and-link-affordable-telephone-service-income-eligible-consumers) Low Income Home Energy Assistance Program: Help with weatherization and heating and cooling costs ( Medicaid: Help with medical expenses through local social services office ( Medicare Part D Extra Help: Help with prescription drug costs ( Medicare savings plans: Help with Medicare premiums, co-pays, and deductibles ( Social Security Disability: Income support for persons with disabilities ( State pharmaceutical assistance programs: Help with prescription drug costs ( State property tax relief: State programs to lower property taxes ( _Residential_Property_Tax_Relief_Programs.aspx) Supplemental Security Income: Income support for persons who are over 65, blind, or disabled with very limited income ( /disabilityssi/ssi.html) Veterans benefits: Benefits for veterans of the U.S. military service ( 159
10 Checklist for Family Caregivers Expenses The person I care for has the following expenses: Item Rent Mortgage Home repair Housekeeping Yard care Homeowner s insurance Household supplies Security system Medical alert Gas Electric Water/sewer Phone (land) Phone (mobile) Fuel oil Internet access Cable Medicare Part B premium Medicare Part D premium Medicare Advantage premium Medicare supplement premium Long-term care insurance premium Medications Medical co-payments/deductibles Home care/caregiver Amount On Autopay Yes No 160
11 Chapter 7: Money Matters Car insurance Car repair/maintenance Car registration Parking Gasoline Taxes Credit card debt Groceries Entertainment Pet care Gifts Membership dues Subscriptions TOTAL MONTHLY EXPENSES 161
12 Checklist for Family Caregivers Credit and Debit Cards The person I care for has the following credit or debit cards: Name of credit card: PIN: Name(s) on account: Monthly payments are on autopay. Name of credit card: PIN: Name(s) on account: Monthly payments are on autopay. Name of credit card: PIN: Name(s) on account: Monthly payments are on autopay. 162
13 Chapter 7: Money Matters Name of credit card: PIN: Name(s) on account: Monthly payments are on autopay. Name of credit card: PIN: Name(s) on account: Monthly payments are on autopay. Name of credit card: PIN: Name(s) on account: Monthly payments are on autopay. Location of usernames and passwords for online access: 163
14 Checklist for Family Caregivers Lawsuits and Judgments The following lawsuits or legal claims are pending: Case name: Court: Attorney: Type of lawsuit or legal claim: Case name: Court: Attorney: Type of lawsuit or legal claim: The following legal judgments are uncollected: Case name: Court: Attorney: Type of judgment: Case name: Court: Attorney: Type of judgment: 164
15 Chapter 7: Money Matters Outstanding Loans The following people owe money to the person I care for: Name of borrower: Name of borrower: Name of borrower: 165
16 Checklist for Family Caregivers Personal Debts The person I care for owes the following people or entities money: Internal Revenue Service: Terms of debt: State Department of Taxation: Terms of debt: Name of lender: Terms of debt: 166
17 Chapter 7: Money Matters Name of lender: Terms of debt: Name of lender: Terms of debt: Name of lender: Terms of debt: 167
18 Checklist for Family Caregivers Reverse Mortgage There is a reverse mortgage on the home: Property address: Financial institution: Phone: Fax: Type of reverse mortgage: Mortgage account #: Current amount of debt: $ Website: 168
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IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT ST. CLAIR COUNTY, ILLINOIS IN RE THE MARRIAGE OF: and Petitioner No.: Respondent FINANCIAL STATEMENT 1 2 GROSS WAGES OR SALARY ADDITIONAL INCOME (State
Thanks for making an appointment to see us!
Thanks for making an appointment to see us! Please fill out the following forms before your first bankruptcy consultation at Friedman Iverson. These forms help us understand your financial issues and quickly
Statement of Financial Circumstances (Child support reviews)
Statement of Financial Circumstances (Child support reviews) Your financial circumstances are relevant to the AAT s decision. This form must be completed and returned to the AAT within the timeframe specified