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IOLTA SERVICE AND CASE REPORT FORM (ISCRF)
FOR PROGRAMS PROVIDING LEGAL ASSISTANCE
PART ONE:
INDIVIDUAL CASE SERVICE REPORT
UNDER
CLIENT AGE AND ETHNICITY: 18 18 - 59 60 + TOTAL
ORGANIZATION NAME: WHITE
BLACK
HISPANIC
YEAR ENDING: NATIVE AMERICAN
TOTAL CASES OPENED: ASIAN/PACIFIC ISLANDER
TOTAL CASES CLOSED: TOTAL
MAJOR REASON CASE CLOSED
A. B. C. D. E. F. G. H. I. J. K.
COURT DECISION
ELIGIBLE STATUS
INSUF. MERIT TO
CLIENT W/DREW
W/O LITIGATION
OR NO RETURN
ADMIN AGENCY
NEGOT SETTLE
NEGOT SETTLE
BRIEF SERVICE
REFER AFTER
W/LITIGATION
TOTAL
COUNSEL &
PROCEED
DECISION
CHANGE
ASSESS
ADVISE
OTHER
LEGAL PROBLEM/CODE
CONSUMER/FINANCIAL:
BANKRUPTCY 01
COLLECTION 02
CONTRACTS 03
CREDIT ACCESS 04
ENERGY 05
LOANS 06
PUBLIC UTILITIES 07
UNFAIR SALES 08
OTHER CONSUMER 09
TOTAL CONSUM/FINAN
EDUCATION 11
EMPLOYMENT:
JOB DISCRIM 21
WAGE CLAIMS 22
OTHER EMPLOYMT 29
TOTAL EMPLOYMENT
2011 IOLTA GRANT
Annual Service and Case Report 1
IOLTA SERVICE AND CASE REPORT FORM (ISCRF)
FOR PROGRAMS PROVIDING LEGAL ASSISTANCE
MAJOR REASON CASE CLOSED
A. B. C. D. E. F. G. H. I. J. K.
COURT DECISION
ELIGIBLE STATUS
INSUF. MERIT TO
CLIENT W/DREW
W/O LITIGATION
OR NO RETURN
ADMIN AGENCY
NEGOT SETTLE
NEGOT SETTLE
BRIEF SERVICE
REFER AFTER
W/LITIGATION
TOTAL
COUNSEL &
PROCEED
DECISION
CHANGE
ASSESS
ADVISE
OTHER
LEGAL PROBLEM/CODE
FAMILY:
ADOPTION 30
CUSTODY/VISITATION 31
DIV/SEP/ANNUL 32
GUARDIAN/CONSERV 33
NAME CHANGE 34
PARENTAL RIGHTS
TERMINATION 35
PATERNITY 36
SPOUSE ABUSE 37
SUPPORT 38
OTHER FAMILY 39
TOTAL FAMILY
JUVENILE:
DELINQUENT 41
NEGLECT/ABUSE 42
OTHER JUVENILE 43
TOTAL JUVENILE
HEALTH:
MEDICAID 51
MEDICARE 52
OTHER HEALTH 59
TOTAL HEALTH
HOUSING:
FED'L SUB RIGHTS 61
OWNER/REAL
PROPERTY 62
LANDLORD/TENANT 63
OTHER PUB HOUSING 64
OTHER HOUSING 69
TOTAL HOUSING
2011 IOLTA GRANT
Annual Service and Case Report 2
IOLTA SERVICE AND CASE REPORT FORM (ISCRF)
FOR PROGRAMS PROVIDING LEGAL ASSISTANCE
MAJOR REASON CASE CLOSED
A. B. C. D. E. F. G. H. I. J. K.
COURT DECISION
ELIGIBLE STATUS
INSUF. MERIT TO
CLIENT W/DREW
W/O LITIGATION
OR NO RETURN
ADMIN AGENCY
NEGOT SETTLE
NEGOT SETTLE
BRIEF SERVICE
REFER AFTER
W/LITIGATION
TOTAL
COUNSEL &
PROCEED
DECISION
CHANGE
ASSESS
ADVISE
OTHER
LEGAL PROBLEM/CODE
INCOME MAINTENANCE:
WELFARE 71
BLACK LUNG 72
FOOD STAMPS 73
SOCIAL SECURITY 74
SSI 75
UNEMPLOYMENT 76
VETERAN BENEFITS 77
WORKERS COMP 78
OTHER INC MAINT 79
TOTAL INCOME MAINT
INDIVIDUAL RIGHTS:
IMMIGRATION/NATRL 81
MENTAL HEALTH 82
PRISONER RIGHTS 83
PHYSICAL DISABILITY 84
OTHER INDIV RIGHTS 89
TOTAL INDIV RIGHTS
MISCELLANEOUS:
INCORP/DIS 91
INDIAN/TRIBAL 92
LICENSE 93
TORTS 94
WILLS/ESTATE 95
OTHER MISC 99
TOTAL MISC
TOTAL CASES
ATTACH THE COMPLETED IOLTA IMPACT LITIGATION AND COMMUNITY LEGAL EDUCATION FORM- THIS
REPORT IS NOT COMPLETE WITHOUT IT!
2011 IOLTA GRANT
Annual Service and Case Report 3
