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EXHIBIT 2 PATIENT/PAYMENT SOURCE FINANCIAL WORKSHEET Patient Name: ___ Household Size: ___ 1A1BCalculation of Available Income Monthly Salary/Pension Monthly SSI/VA Income Total Calculation of Monthly
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How to fill out statement of household expenses

01
Gather all your receipts for household expenses such as rent/mortgage, utilities, groceries, and other monthly bills.
02
Organize the receipts by category to make filling out the statement easier.
03
Create a list of all household expenses for the month, including the amount spent on each category.
04
Total up the expenses for each category to get the overall household expenses for the month.
05
Fill out the statement of household expenses form with the total amount spent in each category and any other required information such as income and savings.
06
Review the completed form for accuracy and make any necessary corrections before submitting it.

Who needs statement of household expenses?

01
Individuals applying for financial assistance programs
02
Homeowners applying for a mortgage loan
03
Budget-conscious individuals looking to track and manage their expenses
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The statement of household expenses is a document that outlines the expenses incurred by a household over a certain period of time.
Individuals who are claiming household expenses as deductions on their taxes are required to file a statement of household expenses.
To fill out a statement of household expenses, you will need to list all the expenses incurred by your household, including details such as dates, amounts, and purposes of each expense.
The purpose of the statement of household expenses is to provide documentation of the expenses incurred by a household in order to claim deductions on taxes.
The information that must be reported on a statement of household expenses includes details of all expenses incurred, such as dates, amounts, and purposes.
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