This is your Member Reference Number (MRN). You’ll need to provide this when you make an appointment with an EAP counselor or contact your EAP by phone.

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Benefits with The Local Choice

Your EAP offers these great resources.

General Budget Worksheet

Track your income and expenses here.

Monthly Income
Income (Monthly)Current
Base Pay (Net)$ ________.____
Other Job Take-Home Pay$ ________.____
Other Income (Monthly)$ ________.____
Child Support/Alimony$ ________.____
Benefits$ ________.____
Rental Home Income$ ________.____
Retirement Pay$ ________.____
Social Security Benefits$ ________.____
Survivor Benefit Plan$ ________.____
Interest/Dividends$ ________.____
Other$ ________.____
Other$ ________.____
Total$ ________.____
Total of All Income$ _______.____


Monthly Expenses
ExpensesAmount
Housing (Rent/Mortgage)$ ________.____
Housing Maintenance $ ________.____
Electric$ ________.____
Gas/Oil$ ________.____
Water/Sewer$ ________.____
Telephone (Home)$ ________.____
Telephone (Cellular)$ ________.____
Trash Pickup$ ________.____
Cable/Satellite/Internet$ ________.____
Automobile Payment$ ________.____
Auto Insurance$ ________.____
Life Insurance$ ________.____
Child Support/Alimony$ ________.____
Medical Insurance$ ________.____
Entertainment/Hobbies$ ________.____
Alcohol/Cigarettes$ ________.____
Barber/Beauty$ ________.____
Pet Costs$ ________.____
Property Tax (Monthly Figure)$ ________.____
Savings$ ________.____
Food Costs (Work and School)$ ________.____
Food (Groceries)$ ________.____
Clothing$ ________.____
Transportation (Gas, Bus, or Subway Fare)$ ________.____
Car Maintenance$ ________.____
Personal Needs$ ________.____
Child Care$ ________.____
One Time/Annual Expenses$ ________.____
Other Health Costs$ ________.____
Other$ ________.____
Other$ ________.____
Other$ ________.____
Debt Payments (Credit Cards, Loans, etc.)$ ________.____
Total Expenses$ _______.____


Monthly Totals
Monthly Totals
Total
Total Income$ ________.____
Total Expenses$ ________.____
Surplus/Deficit (Difference + or –)$ _______.____

Workplace Options (WPO). (Revised 2023). General budget worksheet (B. Schuette, Ed.). Raleigh, NC: Author.

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