Budget If Disabled
My Cash Flow On Disability |
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| DATE | ||
| LAST REVISED: | ||
Income |
|||
| Income Sources | Current | 1st 6 Months of Disabilty | After 6 Months |
|---|---|---|---|
| Your Job | |||
| Spouse/Partner's Job (if any) | |||
| Other Job | |||
| Self-Employment Income | |||
| Unemployment Benefits | |||
| Short-Term Disability Income (State) | |||
| Short-Term Disability Income (Employer) | |||
| Private Long-Term Disability | |||
| Social Security Disability Income | |||
| Pension Income | |||
| Supplemental Security Income | |||
| Food Stamps | |||
| Other Income: | |||
| Other Income: | |||
| Total Income | |||
Medical Expenses |
|||
| Expense | Current | 1st 29 Months | After 29 Months |
|---|---|---|---|
| Insurance Premiums | |||
| Deductibles | |||
| Medical office/hospital copayments | |||
| Prescription & Prescription copayments | |||
| Eyeglasses / Contact Lenses | |||
| Over-the-counter Medications | |||
| Nutritional Supplements | |||
| Medical Equipment | |||
| Medical Supplies | |||
| Home Care | |||
| Dental | |||
| Therapy | |||
| Alternative Therapies | |||
| Experimental Treatments | |||
| Other | |||
| Total Medical Care | |||
Food |
||
| Type | Current | If Disabled |
|---|---|---|
| Supermarket | ||
| Restaurant / Takeout | ||
| Tobacco / Alcohol | ||
| Vitamins | ||
| Other | ||
| Other | ||
| Total Food | ||
Transportation |
||
| Expense | Current | If Disabled |
|---|---|---|
| Car loan(s) and/or lease(s) | ||
| Auto 1 Insurance | ||
| Auto 2 Insurance | ||
| Gasoline, Oil | ||
| Maintenance, Repair | ||
| Public Transportation | ||
| Tolls | ||
| Registration | ||
| Other | ||
| Other | ||
| Total Transportation | ||
Household Expenses |
||
| Expense | Current | If Disabled |
|---|---|---|
| Rent / Mortgage Payments / Maintenance | ||
| Electricity | ||
| Oil | ||
| Gas | ||
| Water / Sewer | ||
| Telephone | ||
| Mobile Phone(s) | ||
| Cable / Satellite TV | ||
| Internet Access | ||
| Property Taxes | ||
| Renters or Home Insurance | ||
| Maintenance / Repairs | ||
| Home Furnishings | ||
| Other | ||
| Other | ||
| Total Household Expenses | ||
Personal Care |
||
| Personal Care | Current | If Disabled |
|---|---|---|
| Hair Care / Haircuts | ||
| Wigs / Hairpieces | ||
| Makeup | ||
| Toiletries | ||
| Clothing | ||
| Dry Cleaning / Laundry | ||
| Tailor | ||
| Gym Membership | ||
| Other | ||
| Other | ||
| Total Personal Care | ||
Recreation |
||
| Type of Recreation, Hobby, Etc. | Current | If Disabled |
|---|---|---|
| Vacation / Travel | ||
| Movies / Theatre | ||
| Parties At Home | ||
| Newspapers, Books | ||
| Music CDs | ||
| Software | ||
| Pet Food / Supplies | ||
| Vet Expenses | ||
| Movie Rentals / Videos | ||
| Other | ||
| Other | ||
| Total Recreation | ||
Professional Services (Non-Medical) |
||
| Service | Current | If Disabled |
|---|---|---|
| Lawyer | ||
| Accountant | ||
| Financial Planner | ||
| Other | ||
| Other | ||
| Total Professional Services | ||
Childcare |
||
| Childcare | Current | If Disabled |
|---|---|---|
| Day Care / Babysitting | ||
| Toys / Clothing | ||
| Education / Books | ||
| Other | ||
| Other | ||
| Total Childcare | ||
Debts and Obligations |
||
| Category | Current | If Disabled |
|---|---|---|
| Estimated Federal Tax Payments | ||
| Estimated State Tax Payments | ||
| Alimony / Child Support | ||
| Credit Card Payments | ||
| Student Loans | ||
| Other | ||
| Other | ||
| Total Debts and Obligations | ||
Savings and Income Protection |
||
| Savings and Income Protection | Current | If Disabled |
|---|---|---|
| "Just In Case" Fund | ||
| Disability insurance not paid through employer | ||
| Life insurance not paid through employer | ||
| Investments | ||
| Other | ||
| Other | ||
| Total Savings | ||
Gifts and Contributions |
||
| Savings and Income Protection | Current | If Disabled |
|---|---|---|
| Birthday Gifts | ||
| Holiday Gifts | ||
| Place of Worship | ||
| Other Charities | ||
| Other | ||
| Other | ||
| Total Gifts and Contributions | ||
| When do you want to plan for going on disability? | Month | |||||||||
| Year | ||||||||||
| What inflation rate do you want to account for? | ||||||||||
Monthly Cash Flow Projections For Disability Lasting Up To 5 Years |
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| Today | through | through | through | through | through | through | through | |||
| Monthly Income | ||||||||||
| Monthly Expenses | ||||||||||
| Monthly Cash Flow | ||||||||||
Savings Needed To Supplement Income* |
||||||||||
| Length of Disability | Amount to Save by Start of Disability | |||||||||
| One Year | ||||||||||
| Two Years | ||||||||||
| Three Years | ||||||||||
| Four Years | ||||||||||
| Five Years | ||||||||||
| (*assuming 4% after-tax return on savings during disability. See Investing for Your Time Horizon) | ||||||||||
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