Form Sr 2j - Client Days By Month (Occupancy)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CLIENT DAYS BY MONTH
(Occupancy)
Group Home: _______________________________________________
Audit Period: _____________________________
AFDC Eligible Clients
Agency
Place Date
July
August
September
October
November December
January
February
March
April
May
June
Discharge Date
Total Client Days
DATE
INITIALS
DATE
INITIALS
Prepared by
Approved by
SR 2J (12/02)

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