LIFE’S CHECKLISTS · FREE WORKSHEET
Utility bill review
Use your actual documents and the organization’s current instructions. Record questions and confirmations; this worksheet does not establish rights, eligibility or deadlines.
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.
Completed example
This is a fictional practice entry. Write your own details in the blank sections below.
- Bill period
- September example
- Usage / rate shown
- 100 units at $0.10/unit
- Charge to ask about
- Separate $5 service charge
- Provider explanation
- Provider says fixed monthly fee; written explanation saved
- Confirmed due date
- October 28 on sample bill
- Next contact
- October 26 if explanation still unclear
Date: ____________________
Item 1
Usage / rate shown
Charge to ask about
Provider explanation
Confirmed due date
Next contact
Item 2
Usage / rate shown
Charge to ask about
Provider explanation
Confirmed due date
Next contact
Item 3
Usage / rate shown
Charge to ask about
Provider explanation
Confirmed due date
Next contact
Item 4
Usage / rate shown
Charge to ask about
Provider explanation
Confirmed due date
Next contact
Notes: