MA Money Management Program
Volunteer Monthly Report - Client Visitation (No Cash)
Always leave client name OFF online report.
Cash requires signature.
Volunteer Name
*
First Name
Last Name
Volunteer Email
*
(A summary of this report will be sent to this email address)
Number of Consumer Visits
*
(How many visits does this report cover?)
Date(s) of Consumer Visits
*
(Please enter as MM/DD/YYYY and separate by commas)
Time Spent
*
(Total time spent over all visits covered by this report)
Does bank statement include check images?
*
Yes
No
Does the client receive MassHealth and/or SSI benefits?
*
Yes
No
Is the ending bank balance below the MassHealth limit requirement of $2,000 for an individual and $3,000 for a couple?
*
Yes
No
Is the ending bank balance below the MMP suggested limit of $5,000?
*
Yes
No
The MMP volunteer and the client met "in person" this month.
*
Yes
No
Volunteer service provided
*
Problems encountered
*
Comments
*
Mileage
Date of next visit
-
Month
-
Day
Year
Date
Signature of volunteer
*
By typing your name here, you confirm that all information on this form is complete and correct.
Please verify that you are human
*
Submit
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