INDIVIDUAL FINANCIAL PROFILE (IFP)	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	Qtr 2	Qtr 4/IP
Complete the IFP with accurate information at minimum on intake and annually. If the client has 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	Penelope Pine	Social Security Rep-Payee/Relationship	Clyde Clipper/Guardian
Total number of people sharing expenses	3	PS-Day?	Yes	x	No
Savings Account	As of date	02-07-11	Balance	400 .00
Checking Account	As of date	02-07-11	Balance	300 .00
MONTHLY INCOME
Employment
SSA	471 .00
SSI	223 .00
Foodstamps
Other (specify)
Total Monthly Income	694 .00
MONTHLY EXPENSES
Housing
Rent/Room & Board	Total amount each month	1052 .00	Individual's portion	263 .00
Power/Water	104 .00
Telephone	5 .00
Gable TV	12 .00
Garbage
Lawn Service	10 .00
Other (specify)	pest control	6 .00
HOUSING Subtotal	400 .00
Food/Household	This includes foodstamps for food and cash for non-food items.	100 .00	100 .00
Transportation	Type? Bus, taxi, other?	0 .00	0 .00
Personal
Entertainment	40 .00
Clothing/Personal	20 .00
Health Related	40 .00
Insurance
Maid
Spending Money
Laundry Money
Other (specify)
100 .00
Total Monthly Expenses	600 .00
COMPARISON OF MONTHLY INCOME WITH MONTHLY EXPENSES
Total Monthly Income	694 .00
Total Monthly Expenses	600 .00
Total Monthly Income minus Monthly Expenses	94 .00
To meet projected expenses, present monthly income will be	Sufficient	x
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
x	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