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Attachment 3 <br /> MONTHLY STATISTICAL REPORT <br /> INSTRUCTIONS <br /> Monthly statistical reports are required by the Division of <br /> Aging to document all Title III-funded services. For most <br /> services, providers are required to submit the name and <br /> social security number of each -recipient. However, due to <br /> lawyer/client confidentiality, that requirement is waived for <br /> the provision of legal services. <br /> In completing the form provided the legal service provider <br /> should assign each case an anonymous code, not to exceed nine <br /> digits or characters. This code should be listed in the <br /> social security number column of the report form. <br /> The number of units of service should be recorded on the day <br /> provided. Units are to be totaled per person and per day. <br /> Reimbursement will be made based on the total units of <br /> service recorded for the month. The form must be signed and <br /> dated. Please submit the original form to the Department on <br /> Aging no later than the third working day of the following <br /> month. <br />