Probation Supervision Report PDF Details

The Probation Supervision Report Form (PSRF) is a document used by probation officers in the United States to report on the status of an offender's supervision. The PSRF is also used to document violations, changes in residence or employment, and other noteworthy events during the course of supervision. The form must be filed within 10 days of the event being reported. The PSRF is divided into two sections: narrative and statistical. The narrative section includes details about the event being reported, while the statistical section provides information about the offender's criminal history and current supervision restrictions. The form can be completed online using Adobe Acrobat Reader, or it can be filled out manually and then scanned and uploaded into the system.

Below is the data about the file you were in search of to fill out. It will tell you just how long it will need to fill out probation supervision report, what fields you need to fill in, etc.

QuestionAnswer
Form NameProbation Supervision Report
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessupervision report form, monthly probation form, probation online reporting, online reporting probation

Form Preview Example

This Report must be received by your officer between the 1st and 5th day of each month. Officer_________________

MONTHLY SUPERVISION REPORT FOR

, 20_______

 

 

 

 

 

 

 

 

 

 

 

 

PART A: NAME and RESIDENCE

 

 

 

 

 

 

 

Name:

 

 

 

Street Address, Apt #:

 

 

 

Home Phone:(

)

 

City, State, Zip:

 

 

 

 

 

 

 

 

 

 

 

Cell/Pager #:(

)

 

Other Mailing Addresses:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Persons living with you (list name and relationship):

Did you move during the month?

Yes [

]

No [

] (If yes, attach lease/purchase agreement)

List all Websites or E-Mail addresses that you maintain or control directly or indirectly:

 

 

 

 

 

 

 

 

 

 

 

 

 

PART B: EMPLOYMENT (If unemployed, list source of support under Part C)

 

Name of Company:

 

 

 

 

Name of Supervisor:

 

Address:

 

 

 

 

City, State:

 

 

 

 

 

 

 

 

 

 

 

 

Phone # of Employer:

 

 

 

 

Position Held:

 

 

 

 

 

 

 

Work Hours:

 

 

Is your employer aware you are on supervision? Yes [

]

No [

]

 

 

 

 

 

 

 

Did you change jobs during the month?

Yes [

]

No [

] If yes, when and why?

 

 

 

 

 

 

 

 

Did you miss work during the month?

Yes [

]

No [

] Explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART C: MONTHLY FINANCIAL STATEMENT

MONTHLY INCOME

 

 

 

 

 

NECESSARY MONTHLY EXPENSES

 

 

Net Income from Employment

 

 

 

 

 

 

Home Mortgage/Rent:

 

 

 

(*attach proof of earnings/paystubs)

 

 

 

 

Grocery:

 

 

 

 

 

 

 

 

 

 

Utilities:

 

 

 

Spouse’s Income:

+

 

 

 

 

 

Medical/Insurance:

 

 

 

 

 

 

 

 

 

 

Telephone:

 

 

 

Other Income (source):

+

 

 

 

 

 

Credit Cards:

 

 

 

 

 

 

 

 

 

 

Car Insurance:

 

 

 

 

+

 

 

 

 

 

Transportation/Gas:

 

 

 

 

 

 

 

 

 

 

Child Support

 

 

 

 

 

 

 

 

 

 

Restitution/Fine/Elec. Monitoring:

 

 

 

 

 

 

 

 

 

 

Other: Explain

 

 

 

TOTAL MONTHLY INCOME: =

 

 

 

 

TOTAL MONTHLY EXPENSES:=

 

 

 

Do you have checking/saving(s) account(s)?

Yes [ ] No [ ]

If yes, give bank name, account number and balances:

Checking [

] Savings [

]

 

 

Checking [

] Savings [

]

 

 

Does your spouse, significant other, or dependent have a checking/savings account that you enjoy the benefits of or make

contributions toward?

Yes [

] No [

] If yes, give bank name, location and balance:

 

 

 

 

 

Did you file bankruptcy during the month?

Yes [

] No [

]

-COMPLETE OTHER SIDE-

PART D: VEHICLES/BOATS/MOTORCYCLES (Vehicles owned or driven by you during the month)

1.Year/Make/Model: __________________Color: __________ Tag #: ____________ Owner: ___________________

2.Year/Make/Model: __________________Color: __________ Tag #: ____________ Owner: ___________________

3.Year/Make/Model: __________________Color: __________ Tag #: ____________ Owner: ___________________

PART E: COMPLIANCE WITH CONDITIONS OF SUPERVISION DURING THE MONTH

W ere you arrested or questioned by a

 

 

Yes [

]

No [

] If yes, give reason, date and agency:

 

law enforcement officer or did you appear in

 

 

 

 

 

 

 

 

 

 

 

 

court for any criminal, civil or traffic matter?

 

 

 

 

 

 

 

 

 

 

 

 

W as anyone in your household arrested

 

Yes [

]

No [

] If yes, give who and reason:

 

or questioned by a law enforcement officer?

 

 

 

 

 

 

 

 

 

 

 

 

Did you have any contact with anyone with

Yes [

]

No [

] If yes, give full name and reason:

 

a felony record?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Did you possess or have access to a firearm?

 

Yes [

]

No [

] If yes, explain:

 

 

Did you possess O R use any illegal drugs?

Yes [

]

No [

] If yes, type of drug and date:

 

 

 

Did you pay fees this month toward a special

Yes [

]

No [

] If yes, amount paid and/or hours completed :

 

assessment, fine, restitution AND/OR complete any

 

 

 

 

 

 

 

 

 

 

 

 

community service?

 

 

 

 

 

 

 

 

 

 

 

 

Did you leave the district without permission?

Yes [

]

No [

] If yes, explain:

 

 

Do you have a safe deposit box?

 

 

Yes [

]

No [

] If yes, location:

 

 

Do you have a storage space?

Yes [

]

No [

] If yes, location:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WARNING: ANY FALSE STATEMENTS MAY RESULT IN REVOCATION OF PROBATION, SUPERVISED RELEASE, OR PAROLE, IN ADDITION TO 5 YEARS IMPRISONMENT, A $250,000 FINE, OR BOTH. (18 U.S.C. § 1001)

I CERTIFY THAT ALL INFO RM ATIO N FURNISH ED IS CO M PLETE AND CO RRECT TO THE BEST OF M Y K NO W LEDGE:

Signature

Date

 

 

 

This form m ay be downloaded at www .ncm p .uscourts.gov/form s

 

 

 

 

REM ARK S:

RECEIV ED:

 

 

M ail

 

 

 

 

PO/CO

 

 

 

 

PH/CH

 

 

 

 

PC/CC

 

U . S. Probation O ffice

 

 

 

 

 

 

 

 

U . S. Probation Officer

Date

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