Free Printable Work Hours Log for Medicaid and SNAP
When a caseworker asks for your hours, a shoebox of receipts and a phone full of screenshots is hard to turn into a number. A one-page-per-month log turns it into a total you can point to, with the proof listed next to each line. Here is ours, free to print, with no sign-up.
What's on the sheet
- Your name, month, state, program and case number at the top
- 31 lines, one per day: date, activity (job, gig, volunteer, work program or school), start, end, hours and pay
- Who can confirm: a name and phone or email for each line
- Proof kept: pay stub, app screenshot, sign-in sheet
- Month totals by activity, total hours toward 80, total pay, and a signature and date line
How to fill it in
- Start a new sheet on the 1st of each month.
- Write each activity on the day you do it. If you work two things in one day, use two lines.
- Use real start and end times and round to the nearest quarter hour.
- Note the proof you kept and keep it together, in an envelope or a phone folder by month.
- At month end, add up the hours by type and the total. For Medicaid, also add your pay: $580 or more in a month meets the rule on its own.
- Sign and date it, make a copy, and keep every month.
Prefer to copy it?
| Date | Activity | Start | End | Hours | Pay (if any) | Who can confirm | Proof kept |
|---|---|---|---|---|---|---|---|
| Example: Mar 3 | Job | 9:00 | 2:30 | 5.5 | $66 | Store manager, name and phone | Pay stub |
| Example: Mar 4 | Gig | 5:00 | 9:00 | 4 | $58 | Delivery app account | Screenshot of trips |
| Example: Mar 6 | Volunteer | 10:00 | 1:00 | 3 | Food bank volunteer lead | Sign-in sheet | |
Quick rules recap
- Medicaid (from January 1, 2027, or earlier if your state chooses): adults 19 to 64 in the expansion group show 80 hours a month of work, community service, a work program or half-time school, in any mix, or $580 of monthly income. If the state can't confirm it, you get 30 days to show it. What counts.
- SNAP: able-bodied adults without dependents, now ages 18 to 64, get 3 months of benefits in 3 years unless they work or join a work program 80 hours a month. SNAP rules.
Your state may have its own form. If it does, use it, and keep this log as your backup.
Common questions
Is this an official government form?
No. It is a free record-keeping sheet from VNCNT Labs. Your state may have its own form or portal, and it decides what proof it accepts. Use this log to keep your own record and fill in their form from it.
Do I have to sign it?
Signing and dating your log at month end is a good habit: it shows when you wrote it and that you stand behind it. Your state may also ask for a signed statement of its own.
Can I use it for both Medicaid and SNAP?
Yes. Circle the program at the top. The activity columns cover both programs.
Does it cost anything?
No. The PDF and the spreadsheet are free to download, print and share. There is no sign-up and no email.
80 Hours and this guide are made by VNCNT Labs. We are not a government agency and are not connected to any state Medicaid or SNAP office. This is general information, not legal advice. Rules vary by state, and your state decides who must report, what counts and what proof it accepts.
Official sources
- CMS: Medicaid community engagement requirement interim final rule, fact sheet (CMS-2454-IFC)
- Federal Register: Medicaid Program; Community Engagement Requirement for Certain Individuals (June 3, 2026)
- USDA: SNAP work requirements
- USDA: SNAP provisions of the One Big Beautiful Bill Act of 2025, ABAWD exceptions implementation memo