Child Care Wage Project Monthly Income/expenses Worksheet
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2Child Care WAGE$® Project Monthly Income & Expenses Worksheet
This sheet helps us determine your monthly earnings from your child care home. Use figures from last month to answer each question. If last
month does not reflect an average month, use the most recent month which does. Receipts are not required, but you must sign where
indicated to verify its accuracy. This is a two-page document. Please complete both pages.
•
To show your INCOME, please complete the following chart. You do not need to list the children’s names, but you must indicate
how much you receive for the care of each child in your home.
•
Under “Parent Fees, ” list only the amount paid to you by the parent(s) of each child. Is this a weekly or monthly payment? Circle the
correct pay period.
•
If subsidy helps pay the cost of care, write the amount you receive in subsidy for each child in the appropriate box.
•
What time does each child typically arrive and when does s/he leave? Please list the typical days and hours each
child attends your program in the final box. All part-time and full-time children should be listed here.
•
List income from drop-in care and the food program below the chart. If you provide shift care and need more
space, please write the additional information on a separate sheet and sign your name to verify accuracy.
Income worksheet
Children
Parent Fees Received
Subsidy Received
Ages of
Typical Days and Hours of Care
in Care
for Each Child
for Each Child
children
for Each Child
(do NOT include subsidy here)
(if applicable)
(list days & arrival/departure times)
$ _________ per week / month
Example
$ _______ per month
circle one
$ _________ per week / month
Example
$ _______ per month
circle one
$ _________ per week / month
Child 1
$ _______ per month
circle one
$ _________ per week / month
Child 2
$ _______ per month
circle one
$ _________ per week / month
Child 3
$ _______ per month
circle one
$ _________ per week / month
Child 4
$ _______ per month
circle one
$ _________ per week / month
Child 5
$ _______ per month
circle one
$ _________ per week / month
Child 6
$ _______ per month
circle one
$ _________ per week / month
Child 7
$ _______ per month
circle one
$ _________ per week / month
Child 8
$ _______ per month
circle one
$ _________ per week / month
Child 9
$ _______ per month
circle one
$ _________ per week / month
Child 10
$ _______ per month
circle one
Drop-in care:
I average $_____________per week / per month (circle one) from drop-in care.
Please turn this
worksheet over to
Food program:
I received $ _____________ last month from the Child & Adult Care Food Program.
provide information
on expenses.
How many hours do you work a week?
_____________
Print name ___________________________________________ Social Security # XXX-XX-_____________
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