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FORM P Community Services of Northeast Texas, Inc.
545 Revised 304 E.Houston ● P.O. Box 427
FEB 17, 2018 Linden, Texas 75563
Budget Worksheet Approved for all programs
INCOME 6. TANF
7. VA
List ALL income (monthly amounts) 8. Support from Others
9. Other Income
1. Employment
2. SS/RSDI/SSI Total A (1-9):
3. Unemployment
4. Child Support HAVE YOU APPLIED FOR?
5. Food Stamps
Answer yes or no
EXPENSES Food Stamps
Utility assistance
List amount of expenses TANF
1. Rent/ Mortgage Social Security Benefits
2. Electric Unemployment Benefits
3. Gas WIC
4. Water
5. Phone / Internet OTHER EXPENSES
6. Car Note
7. Car Insurance List amount of expenses
8. House Insurance 1. Charitable Donations
9. Other Insurance 2. Cable TV
10. Furniture 3. Movie Rentals
11. Loan Company 4. Cell Phones
12. Medical 5. Eating Out
13. Credit Cards- Actual Payments 6. Tobacco
7. Child Care
a. 8. Alcohol
b. 9. Youth activities
c. 10. Barber / Salon expenses
14. Food 11. Clothing for work /school
15. Gasoline 12. Other
16. Laundry Mat
17. Property Taxes
18. Household Items
19. Yard Services
Total C (1-12):
Total B (1-19): Total Monthly Income Total A
Total Monthly Expenses Total B
Total Other Expenses Total C
Discretionary Funds A minus (B+C)
Page 11 Revision Date 2/17/2018
Version 9.17
