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INSTRUCTIONS FOR COMPLETING <br />MONTHLY STATISTICAL REPORT <br />Attachment 2A 7 <br />Monthly statistical reports are required by the Division of <br />Aging Services to document all Title III funded services. <br />For most services, providers are regquired to submit the name <br />and social security number of each recipient. However, due <br />to lawyer /client confidentiality, that requirement <br />for the provision, of Legal services. is waived <br />In completing the form provided as Attachment 3, the Legal <br />service provider should assign each case an anomynous cede, <br />not.to exceed nine digits or characters. Thi <br />listed in the social security code should be <br />form. y number column of the report <br />The number of units of service should be recorded on the day <br />provided. Units are to be totaled per <br />Person <br />Reimbursement will be made based on the total un itseo flay. <br />service recorded for the month. The form must be signed and <br />dated. Please submit the original form to the Department or, <br />Y� Aging no later than the fourth working day of the following <br />mont h. lowin g <br />