Monthly Report Form - Pottawatomie County - pottcounty 2026

1. Click ‘Get Form’ to open the Monthly Report Form in the editor.
2. Begin by filling in your Case Number at the top of the form. This is essential for tracking your report.
3. Provide your personal information, including Name, Address, City/State, Zip Code, Telephone Number(s), and E-mail Address. Ensure accuracy for effective communication.
4. Indicate who you are living with by providing their Name and Relationship to you (e.g., spouse, parent).
5. Fill in details about your Present Employer or School Attending along with the Employer’s Address and Phone Number.
6. Describe your type of work and include your Wage (per hour, per week, or per month).
7. List any alternate sources of income if applicable.
8. Document any days absent from work or school, excluding weekends/holidays, along with reasons for those absences.
9. Answer whether you have had any contact with law enforcement since your last report. If yes, provide an explanation.
10. Finally, date the form and sign it at the bottom. If more space is needed for answers or comments, utilize the back of the form.

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