HTML Preview Army Monthly Counseling Form page number 1.
FINANCIAL
COUNSELING
STATEMENT
1. INTERVIEW CONDUCTED
2. DATE OF INTERVIEW
5. LOAN NUMBER
BY PHONE
4. TELEPHONE NUMBERS (Include area code)
IN OFFICE
6. NAME, ADDRESS, AND TELEPHONE NUMBER OF EMPLOYER (Include Area Code)
IN FIELD
10. NAME, ADDRESS, AND TELEPHONE NUMBER OF SPOUSE'S EMPLOYER (Include Area Code)
11. LENGTH OF
EMPLOYMENT
12. TYPE OF WORK
9. AGE OF
HOMEOWNER
13. AGE OF
SPOUSE
7. LENGTH OF
EMPLOYMENT
8. TYPE OF WORK
HOME
OFFICE
14. NAME, ADDRESS, AND TELEPHONE NUMBER OF NEXT OF KIN (Include area code)
15. AGE(S) OF OTHER DEPENDENTS
17. ESTIMATED MONTHLY DEBTS (Other than mortgage)
16. AVERAGE MONTHLY INCOME FROM ALL SOURCES
(Disclosure of child support,alimony and maintenance income is optional)
A. SALARIES (Gross pay)
B. COMPENSATION OR PENSION
C. OTHER
D. TOTAL
$
$
$
$
A. NAME OF CREDITOR
B. DATE DUE
C. BALANCE DUE
D. MONTHLY PAYMENTS
TOTAL
$
$
18. REASON FOR DELINQUENCY
$
$
19. DELINQUENCY REGARDED AS
PERMANENT
TEMPORARY
SECTION II - MONTHLY OBLIGATIONS AND BUDGET
PROPOSED
BUDGET
EXISTING
OBLIGATIONS
DESCRIPTION
20.
HOUSE
EXPENSES
$
I. SUB TOTAL
B. PROPERTY TAXES (Not included in "A" above)
$
$
$
C. TELEPHONE AND UTILITIES (Electricity, gas, fuel, water, etc.)
D. HOME MAINTENANCE AND REPAIRS
A. MORTGAGE LOAN PAYMENTS (Include investment properties, rents paid, and subordinate mortgages)
H. HOMEOWNER'S AND/OR PROPERTY INSURANCE PREMIUMS (Not included in "A" shown)
F. HOUSEHOLD FURNISHINGS
G. HOUSEHOLD HELP AND/OR CHILD CARE (Including Social Security, carfare, etc.)
21.
BASIC
FAMILY
EXPENSES
$
$
A. GROCERIES AND HOUSEHOLD ITEMS
B. CLOTHING PURCHASES (Work, children, personal)
E. GARDEN AND POOL MAINTENANCE
C. LAUNDRY AND DRY CLEANING
D. MEDICAL EXPENSES (Physician, dentist, pharmacy)
E. HEALTH INSURANCE PREMIUMS
F. EDUCATION (Tuition, supplies, room and board, etc.)
G. VEHICLE PAYMENTS
H. VEHICLE EXPENSES (Gas, oil, repairs, insurance)
I. COMMUTING EXPENSES (Other than personal vehicles)
J. POCKET MONEY (Allowances, wife, husband, children, lunches)
K. SUB TOTAL
$
$
A. ENTERTAINMENT (Meals, shows, etc.)
$
$
22.
ADDITIONAL
FAMILY
EXPENSES
B. VACATIONS AND CAMPS
C. RECREATION (Skiing, boats, riding, etc.)
D. SPECIAL COURSES OR LESSONS
$
$
E. GIFTS (Birthdays, anniversaries, etc.)
F. CHARITABLE CONTRIBUTIONS
G. CLUB DUES AND EXPENSES
H. BOOKS AND SUBSCRIPTIONS (Record clubs, etc.)
I. PETS (Food, veterinary care)
23. OTHER
EXPENSES
K. SUB TOTAL
VA FORM
JUN 2008
26-8844
A. FEDERAL INCOME TAXES
B. STATE AND CITY INCOME TAXES
= $
$
C. SOCIAL SECURITY TAXES AND/OR RETIREMENT DEPOSIT
D. LIFE INSURANCE PREMIUMS
E. DISABILITY INSURANCE PREMIUMS
F. INSTALLMENT LOAN PAYMENTS (Including interest)
G. PROFESSIONAL SERVICES (Union dues, accounting, legal, investment, etc.)
H. ALIMONY
I. CHILD SUPPORT
J. OTHER EXPENSES
24. TOTAL MONTHLY EXPENSES
J. SUB TOTAL
25. RECAP: INCOME/EXPENSES
$
$
$
$
A. MONTHLY GROSS INCOME (Item 16D)
B. MINUS MONTHLY EXPENSES (Item 24)
$
C. TOTAL
$
- $
SUPERSEDES VA FORM 26-8844, OCT 2004,
WHICH WILL NOT BE USED.
3. NAMES(S) OF PERSON(S) INTERVIEWED
SECTION I - FINANCIAL INFORMATION (Complete VA Form 26-6807, if appropriate)
OMB Control Number: 2900-0270
Respondent Burden: 45 Minutes