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Attachment 3 <br />INSTRUCTIONS FOR COMPLETING <br />MONTHLY STATISTICAL REPORT <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 />