INDIVIDUAL FINANCIAL PROFILE (IFP): ATTACHMENT A & B	Date	02-07-11
Client	MILLIE MCKNIFE	SS #	xxx-xx-xxxx
Address	xxxx - xxth Avenue North St. Petersburg, Fl 33714	Phone #	xxx-xxx-xxxx
Startup Date	Qtr 3/AR	Qtr 1	Oct-Dec (update)	Qtr 2	Qtr 4/IP
Staff assisting with IFP	Penelope Pine	Social Security Rep-Payee/relationship	Clyde Clipper/Guardian
Total number of people sharing expenses	3	PS-Day?	Yes	x	No
x	ATTACHMENT A: Check if the client has PS-Day staff and/or roommates. Complete Attachment A and submit the IFP and attachment to WSC.
ATTACHMENT B: Check if the client is starting up or moving. Complete Attachment B and submit the IFP and attachment to the WSC.
ATTACHMENT A: COMPARISON OF SHARED EXPENSES FOR IN-HOME SUPPORT STAFF/ROOMMATE(S)
HOUSING	PS-Day/Provider	Roommate 1/Individual	Roommate 2	Roommate 3	Total Expenses
Rent/Room & Board	263 .00	263 .00	263 .00	263 .00	1052 .00
Power/Water	104 .00	104 .00	104 .00	104 .00	416 .00
Telephone	5 .00	5 .00	5 .00	5 .00	20 .00
Cable TV	12 .00	12 .00	12 .00	12 .00	48 .00
Garbage	0 .00
Lawn Service	10 .00	10 .00	10 .00	10 .00	40 .00
Other (specify)	pest control	6 .00	6 .00	6 .00	6 .00	24 .00
HOUSING Subtotal	400 .00	400 .00	400 .00	400 .00	1600 .00
FOOD/HOUSEHOLD	100 .00	100 .00	100 .00	100 .00	400 .00
Total Monthly Shared Expenses	500 .00	500 .00	500 .00	500 .00	2000 .00
The provider will pay an equal portion of rent and utilities. The individual/roommate(s) are responsible for the balance of the rent and utilities. The PS-Day staff will receive $100.00 toward food/household. Receipts and expense forms will be maintained.	Amount the provider will pay towards rent:	400 .00
ATTACHMENT B: ONE-TIME SUBSIDY
First month's rent	Telephone deposit
Last month's rent	Telephone hookup
Security deposit	Cable Installation
Pet deposit	Furnishings
Electric deposit	Household supplies
Electric hookup	Pantry stocks
Other (specify)	Moving costs
Total Projected Start-up Expenses	0 .00
Savings Account Balance (from IFP)
Checking Account Balance (from IFP)
Savings + Checking Balance Total	0 .00
Financial Obligations: Amount needed to meet financial obligations prior to move
Funds Available: Savings and Checking minus financial obligations	0 .00
Emergency Funds: Amount to remain in savings for emergencies (living expenses for 2 months is suggested)
Start-Up Funds Available from Client: Funds Available minus Emergency Funds	0 .00
Total Start-Up Expenses: Total projected start-up funds available from client minus start-up expenses	0 .00
Total Start-Up Funds Requested for Individual	0 .00
A positive total represents surplus funds for the individual and NO start-up subsidy should be needed.

A negative (-) total represents the maximum amount of start-up funds needed by the individual.