INDIVIDUAL FINANCIAL PROFILE (IFP)	Date
Client	SS #
Address	Phone #
Startup Date	Qtr 3/AR	Qtr 1	Qtr 2	Qtr 4/IP
Complete the IFP with accurate information at minimum on intake and annually. If the client has a PS-Day staff and/or roommates complete Attachment A and/or if the client is starting up or moving, complete Attachment B. Submit this form and attachments, if needed to the WSC.
Staff assisting with IFP	Social Security Rep-Payee/Relationship
Total number of people sharing expenses	PS-Day?	Yes	No
Savings Account	As of date	Balance
Checking Account	As of date	Balance
MONTHLY INCOME
Employment
SSA
SSI
Foodstamps
Other (specify)
Total Monthly Income
MONTHLY EXPENSES
Housing
Rent/Room & Board	Total amount each month	Individual's portion
Power/Water
Telephone
Gable TV
Garbage
Lawn Service
Other (specify)
HOUSING Subtotal
Food/Household	This includes foodstamps for food and cash for non-food items.
Transportation	Type? Bus, taxi, other?
Personal
Entertainment
Clothing/Personal
Health Related
Insurance
Maid
Spending Money
Laundry Money
Other (specify)
Total Monthly Expenses
COMPARISON OF MONTHLY INCOME WITH MONTHLY EXPENSES
Total Monthly Income
Total Monthly Expenses
Total Monthly Income minus Monthly Expenses
To meet projected expenses, present monthly income will be	Sufficient
Insufficient
Complete Attachment B to determine whether the individual needs start-up financial assistance.
Based on the figures, a monthly stipend is recommended.	Start date	Amount
Based on the figures, a one-time subsidy is recommended.	Start date	Amount from Attachment B
Based on the figures, monthly income is sufficient to meet start-up and/or monthly expenses. No financial assistance is needed at this time.
Individual	Signature	Date
Client
Guardian
Staff
WSC
If a stipend/subsidy is needed, please submit to the District Office and return to the provider after the District Office has approved or denied the request.

Life's New Beginnings, Inc. 7031 Rockwood Drive Port Richey 34668 727-841-7161 Fax: 727-841-7671
District Office

Authorizing Signature	Monthly Stipend	Denied	Approved for $
One Time Subsidy	Denied	Approved for $
Date