View Utility Expense Evidence

Updated On[date-and-time]Updated By[User Name] [View History]
Effective Date of Change[Date] 
Approval Requested[True]Approval Status[Approved] [View History]

Utility Expense Details

Utility Expense Type[field-value] 
Total Expense Amount[Amount]Frequency[Daily]
Start Date[Date]End Date[Date]
Low Income Energy Assistance Payments[True] 

Utility Expense Details

Utility[Full Name]

Reimbursement Details

Reimbursement Type[field-value] 
Reimbursement Amount[Amount] 

Comments

[Comments]