THE CONFIDENTIAL FINANCIAL QUESTIONNAIRE

The Confidential Financial Questionnaire is a form that Grand Jurors must complete and bring to the courthouse when appearing for grand juror service.  The information you provide on the form will be used to determine the amount of compensation paid to you by the Commonwealth for each day after your third day of grand juror service.  The information you provide on the form will be held confidential.
(Click here for information on juror compensation for the first three days of juror service.)

If, after reading the instructions provided on the Questionnaire, you are unsure as to how to properly complete it, we have provided examples of how do to so depending on your financial/employment situation.  The table below lists the different types of situations.  Click on the symbol next to the one that applies to you.

	Your employer will compensate you for the first 3 days and pay your full wages regardless of what the Commonwealth compensates you for each day after the third day of service.
	Your employer will compensate you for the first 3 days only and nothing after the third day of service.
	Your employer will compensate you for the first 3 days and make up the difference between what the Commonwealth compensates you for each day after the third day of service and your regular wages.
	Your employer will compensate you for the first 3 days and pay your full wages for each day after the third day of service, but will require you to turn in any monies received from the Commonwealth.
	You are not employed, or you are at home, or retired.

A copy of this Questionnaire was included in your Grand Juror Summons Package.  If it has been misplaced, there is a version of it online that you may print and then fill-out.
(Click here to view the online version of the Questionnaire)

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