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