Attachment 6 - Records Interview Checklist

Our interview is on __________________ at _________

RECORDS CHECKLIST
FOR THE MONTHS OF

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

COLLECT AND ORGANIZE YOUR HOUSEHOLD’S RECORDS IN 3 STEPS

FIND IT AT HOME OR ONLINE

Housing
⃣

FILE, SAVE, OR PRINT

Insurance

Mortgage loan statement
⃣

Homeowner’s/Renter’s insurance
statement
Health insurance statements
Vehicle insurance statement
Life insurance statements
Other insurance

principal, interest, escrow payments

⃣

Purchase or Sale of a property
⃣

Closing costs, HUD-1 statement

⃣

⃣

Rent
Real Estate or Property Taxes
HOA or Condo Fees
Maintenance and repairs
⃣
⃣
⃣

⃣
⃣

long term care, supplementary health, pet insurance,
umbrella policies, flood insurance

plumbing, gutters, landscaping, construction jobs

⃣

Household operations

Medical Care

moving fees, storage, security

⃣

Out-of-pocket payments
copayments, coinsurance, reimbursable expenses

Utilities
⃣

⃣

Doctor’s appointments, dental visits, eye
exams
Lab tests, x-rays, hospital stays
Adult care

Telephone/Cell phone bill
Cable/Satellite TV bill
Internet bill
Electricity/Natural gas bill
Water/Sewer bill
⃣
⃣
⃣
⃣

Vehicles
⃣

Bill of sale or lease agreement

CHECK THE BOX

⃣

⃣

⃣

⃣

⃣

nursing or convalescent homes, daycare

Eye glasses and hearing aids
Rental equipment
Prescriptions

new, used, or leased cars, boats, campers, motorcycles

⃣
⃣

Financing agreements
Licensing, registration, and inspection fees and
property taxes

⃣
⃣
⃣
Your Field Representative will not collect your records and your
information will remain confidential and not shared with anyone.

⃣

Paystubs
Checkbook registers
Credit Card statements
Bank statements