LIFE’S CHECKLISTS · FREE WORKSHEET

Benefit renewal preparation

Organize administrative questions and next actions. Keep identity numbers, clinical records and children’s identifying information in the responsible organization’s secure process. This is a planning worksheet, not an official application or authorization.

First read the completed example. Then write your own answers in the blank sections. If you do not know an answer, write what you need to ask. Official applications may require their own forms.

Date: ____________________

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