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{"sheet":"Sheet1","index":0,"n_rows":102,"n_cols":7,"rows_kept":102,"cut":false,"hidden":false,"merged":[[6,0,6,8],[18,1,18,6],[21,1,21,6],[84,0,84,7],[94,0,94,7],[62,1,62,2],[41,1,41,2],[42,1,42,2],[13,0,13,7],[10,0,10,7],[90,1,90,2],[91,1,91,2],[92,1,92,2],[73,10,73,12],[74,10,74,12],[67,9,67,11],[68,10,68,12],[69,10,69,12],[71,10,71,12],[101,0,104,7],[17,0,17,7],[97,0,100,7],[39,0,39,7],[49,1,49,2],[52,1,52,2],[88,0,88,7],[89,1,89,2]]}
["FFTTM Budget Assessment"]
[null,"Required elements are underlined."]
[]
["Client Name: ______________________________________________________"]
["Assessment Date: ______________________"]
[]
["Do you want the budget to reflect just your own finances or the finances of your whole household? (Note to participants: please make sure all of your answers for this Budget assessment stay consistent with your response to this question.)"]
[null,"___ Budget reflects participant only or a household of one"]
[null,"___ Budget reflects whole household"]
[]
["Is this the first budget created for this participant?"]
[null,"___ Yes"]
[null,"___ No* "]
["Is this a partial or complete update of the budget?"]
[null,"___ Partial update"]
[null,"___ Complete update"]
[]
["Monthly Income"]
[null,"Are you recording only net income or both net and gross income?"]
[null,"___ Net income only"]
[null,"___ Net and gross income"]
[null,"NOTE: Net income fields are mandatory and will feed FFTTM reports; gross income fields are optional and will not feed FFTTM reports. If you need to estimate net wages, go to www.paycheckcity.com. Remember to take out ALL withholdings (e.g., taxes, benefits premiums, etc.) from net income."]
[null,"Wages (take-home amount after all withholding) (monthly participant income - net)                                                                  ",null,null,null,"Rental Income (monthly participant income - net)"]
[null,"Wages (monthly participant income - gross)",null,null,null,"Rental Income (monthly participant income - gross)"]
[null,"Income from self-employment or business ownership (monthly participant income  - net)",null,null,null,"Interest/Investment Income (monthly participant income - net)"]
[null,"Income from self-employment or business ownership (monthly participant income - gross)",null,null,null,"Interest/Investment Income (monthly participant income - gross)"]
[null,"SSI/SSDI (monthly participant income - net)",null,null,null,"Income from other household members (monthly income from other household members - net)"]
[null,"SSI/SSDI (monthly participant income - gross)",null,null,null,"Social Security (not SSI/SSD) (monthly participant income - net)"]
[null,"SNAP (food stamps)/WIC (monthly participant income - net)",null,null,null,"Social Security (not SSI/SSD) (monthly participant income - gross)"]
[null,"TANF (monthly participant income - net)",null,null,null,"Pensions (monthly participant income - net)"]
[null,"Alimony/Child Support (monthly participant income - net)",null,null,null,"Pensions (monthly participant income - gross)"]
[null,"Alimony/Child Support (monthly participant income - gross)",null,null,null,"Other Public Benefits (monthly participant income - net)"]
[null,"Unemployment (monthly participant income - net)",null,null,null,"Other Public Benefits (monthly participant income - gross)"]
[null,"Unemployment (monthly participant income - gross)",null,null,null,"Other Income (not public benefit) (monthly participant income - net)"]
[null,"Workers' Compensation (monthly participant income - net)",null,null,null,"Other Income (not public benefit) (monthly participant income - gross)"]
[null,"Workers' Compensation (monthly participant income - gross)",null,null,null,"Total Monthly Income (net) ",{"$f":"SUM(E23+E25+E27+E29+E30+E31+E33+E35+E37+G23+G25+G27+G28+G30+G32+G34)","v":0}]
[null,"Veteran Compensation (monthly participant income - net)",null,null,null,"Total Monthly Income (gross)",{"$f":"SUM(E24+E26+E28+E32+E34+E36+E38+G24+G26+G29+G31+G33+G35)","v":0}]
[null,"Veteran Compensation (monthly participant income - gross)"]
[]
["Monthly Expenses"]
[null,"Housing",null,null,null,"Health-Related"]
[null,"Rent (monthly payment)",null,null,null,"Health Ins., if not deducted from your paycheck or Social Security Check (monthly payment)"]
[null,"Renters Insurance (monthly payment)",null,null,null,"Dental Ins., if not deducted from your paycheck or Social Security Check (monthly payment)"]
[null,"Number of mortgages on primary residence",null,null,null,"Life Insurance (monthly payment, pro-rate if not paid monthly)"]
[null,"Mortgage 1 - Primary Residence (monthly payment)",null,null,null,"Monthly medical and prescriptions bills - copays, prescription drugs, etc. (monthly estimate)"]
[null,"Mortgage 2, 3, etc. - Primary Residence (combined monthly payment)",null,null,null,"Other Health-Related Expenses (monthly estimate)"]
[null,"HELOC(s) - Primary Residence (monthly payment)",null,null,null,"Total Health-Related Expenses",{"$f":"SUM(G42:G46)","v":0}]
[null,"Property Tax if not included in mortgage (monthly payment)",null,null,null,"Child/Dependent-Related"]
[null,"Homeowners Insurance (monthly payment)",null,null,null,"Child Support (monthly payment to other parent/guardian)"]
[null,"Home Maintenance (monthly estimate, pro-rated)",null,null,null,"Childcare/Daycare (monthly payment)"]
[null,"Condo/Townhome Fees or Assessments (monthly payment)",null,null,null,"Education (for children/dependents) - tuition, books, pictures, fees, etc. (monthly estimate)"]
[null,"Real Estate Other than Primary Residence (monthly payment)",null,null,null,"Other Child/Dependent-Related Expenses (monthly estimate)"]
[null,"Other Housing Expenses (monthly payment)",null,null,null,"Total Child/Dependent-Related Expenses",{"$f":"SUM(G49:G52)","v":0}]
[null,"Total Housing Expenses ",null,null,{"$f":"SUM(E42+E43+E45+E46+E47+E48+E49+E50+E51+E52+E53)","v":0},"Credit Card/Loan/Other Debt Payments"]
[null,"Utilities",null,null,null,"CC1, CC2, CC3, etc. (combined monthly payment)"]
[null,"Gas/Heating (monthly estimate)",null,null,null,"Student Loan(s) (monthly payment)"]
[null,"Electric (monthly estimate)",null,null,null,"Consumer Loan(s) (monthly payment)"]
[null,"Water (monthly estimate)",null,null,null,"Business Loan(s) (monthly payment)"]
[null,"Trash (monthly estimate)",null,null,null,"Informal Loan(s) - money owed to family, friends, etc. (monthly payment)"]
[null,"Sewer (monthly estimate)",null,null,null,"Other Debt Payments (monthly payment)"]
[null,"Phone - landline (monthly estimate)",null,null,null,"Total Credit Card/Loan/Other Debt Payments",{"$f":"SUM(G55:G60)","v":0}]
[null,"Cell Phone (monthly estimate)",null,null,null,"Personal"]
[null,"Other Utilities Expenses (monthly estimate) (note: cable and internet are located in Personal Expenses)",null,null,null,"Cable/Internet (monthly payment)"]
[null,"Total Utilities Expenses",null,null,{"$f":"SUM(E56:E63)","v":0},"Laundry/Dry Cleaning (monthly estimate)"]
[null,"Food",null,null,null,"Tobacco & Alcohol (monthly estimate)"]
[null,"Groceries (monthly estimate)",null,null,null,"Clothing & Accessories (monthly estimate)"]
[null,"Other Food Expenses - dining out, school lunch, etc. (monthly estimate)",null,null,null,"Hair Products/Toiletries (monthly estimate)"]
[null,"Total Food Expenses ",null,null,{"$f":"SUM(E66:E67)","v":0},"Beauty Salon/Barber Shop (monthly estimate)"]
[null,"Transportation",null,null,null,"Recreation - movies, CD's, sporting events, vacation, etc. (monthly estimate)"]
[null,"Number of vehicles",null,null,null,"Other Personal Expenses (monthly estimate)"]
[null,"Vehicle 1 (monthly payment)",null,null,null,"Total Personal Expenses ",{"$f":"SUM(G63:G70)","v":0}]
[null,"Vehicle 2 (monthly payment)",null,null,null,"Miscellaneous"]
[null,"Vehicle 3, Vehicle 4, Vehicle 5, etc. (combined monthly payment)",null,null,null,"Charitable Giving (monthly estimate)"]
[null,"Gas (monthly estimate)",null,null,null,"Gifts to Others (monthly estimate)"]
[null,"Car Insurance (monthly payment, pro-rate if not paid monthly)",null,null,null,"Newspapers/Magazines (monthly estimate)"]
[null,"Car Maintenance (monthly estimate)",null,null,null,"Pet Care (monthly estimate)"]
[null,"Public Transportation (monthly estimate)",null,null,null,"Allowances for Children/Dependents (monthly estimate)"]
[null,"Other Transportation Expenses (monthly estimate)",null,null,null,"Membership Dues - health club, professional associations, etc. (monthly payment)"]
[null,"Total Transportation Expenses ",null,null,{"$f":"SUM(E71:E78)","v":0},"Education (for participant) - not student loan repayment (monthly estimate)"]
[{"$nulls":5},"Average monthly financial fees from banks/credit unions/currency exchanges - "]
[{"$nulls":5},"i.e. check cashing, money orders, overdraft, ATM (monthly estimate)"]
[{"$nulls":5},"Other Miscellaneous Expenses (monthly estimate)"]
[{"$nulls":5},"Total Miscellaneous Expenses",{"$f":"SUM(G73:G79)+SUM(G81:G82)","v":0}]
[]
["Monthly Savings Target"]
[null,"Monthly Savings Target"]
[]
[]
["Total Monthly Net Income"]
[null,"Total Monthly Income",null," ",null,null,{"$f":"G36","v":0}]
[null,"Total Monthly Expense",null," ",null,null,{"$f":"E54+E64+E68+E79+G47+G53+G61+G71+G83","v":0}]
[null,"Total Monthly Net Income ",null," ",null,null,{"$f":"G90-G91","v":0}]
[null," ",null," "]
[]
["Notes"]
[]
[]
[]
[]
[]
[]
["_____________________________________________________________________________________________________________________________________________________________________________________________________________\nFFT™ is a registered mark of, and FFT™ templates are proprietary to, Local initiatives Support Corporation.  FFT™ includes certain methodology that is confidential and proprietary to Project Match-Families in Transition Association, including specifically the method by which one-time outcomes and over-time outcomes are distinguished, tracked, and entered (including, without limitation, the usage of the status codes such as “beginning”, “interim”, and “end” or terms that embody similar concepts).  You may not disseminate information pertaining to FFT™ or any component thereof (including without limitation third party methodologies) to unauthorized individuals nor embody any component of the FFT™ templates in any products or exploit the same in any way.”  \n\n© Local Initiatives Support Corporation 2012. This work is protected by United States copyright law. Apart from any use as permitted by the U.S. Copyright Act, no part of this document may be reproduced, distributed, transmitted, or published without the express written permission of Local Initiatives Support Corporation. You may not alter or remove any copyright notice or proprietary legend contained in or on this document.\n\nLocal Initiatives Support Corporation does not guarantee the accuracy, completeness, or usefulness of any content in this document or its fitness for any particular purpose."]