| Item |
Amount |
| Savings |
$ |
| Rent or mortgage |
$ |
| Homeowners' or renters' insurance |
$ |
| Condo/townhouse/homeowner association fees |
$ |
| Home repairs or improvements |
$ |
| Groceries |
$ |
| Meals and snacks eaten out |
$ |
| Utilities (electricity, heat, water, etc.) |
$ |
| Transportation (public transportation, car payments, gas, car insurance, maintenance, repairs, etc.) |
$ |
| Vacations |
$ |
| Dental bills |
$ |
| Union and professional dues |
$ |
| Charitable donations |
$ |
| Child care |
$ |
| Child support payments |
$ |
| Loan payments (personal, car, school, etc.) |
$ |
| Life insurance premiums |
$ |
| Credit card bills |
$ |
| Tuition and fees |
$ |
| Cable TV/satellite TV |
$ |
| Internet |
$ |
| Health insurance, prescription drugs, and doctor/dentist bills |
$ |
| Clothing/uniforms |
$ |
| Entertainment (movies, sporting events, concerts, etc.) |
$ |
| Telephone, cellphone, pager |
$ |
| Pet care |
$ |
| Personal (haircuts, toiletries, allowances, etc.) |
$ |
| Miscellaneous (gifts, vacations, etc.) |
$ |
| Costs associated with your child's disability |
| Medical costs (not paid for by insurance or others) |
$ |
| Medical insurance costs (other than Medicaid or Medicare) |
$ |
| Therapy (occupational, physical, etc.) not covered by insurance |
$ |
| Transportation to/from special care or hospital |
$ |
| Lodging and meals incurred during treatment away from home |
$ |
| Child care/nursing care (not covered by insurance) |
$ |
| Assistance for daily living |
$ |
| Legal fees |
$ |
| TOTAL EXPENSES |
$ |
