(1) A municipality may seek reimbursement from any person who is or was a convicted inmate in the municipal jail or in a county jail for expenses incurred by the municipality in relation to the incarceration of that person, as follows:

    (a) Not more than $60.00 per day for the expenses of maintaining that inmate or the actual per diem cost of maintaining that inmate, whichever is less, for the entire period of time the inmate was confined in the municipal jail, including any period of pretrial detention.

    (b) The per-day cost charged to the municipality by a county for housing the inmate in that county’s jail, but not more than $60.00 per day, for the entire period during which the inmate was housed in that county’s jail.

    (c) The cost of providing medical treatment, prescription drugs, dental care, and other medical examinations or procedures.

    (d) To investigate the financial status of the person.

    (e) Any other expenses incurred by the municipality to collect payments under this act.

    (2) Reimbursement under this act may be ordered as a probation condition entered pursuant to section 3 of chapter XI of the code of criminal procedure, 1927 PA 175, MCL 771.3.

    (3) Before seeking any reimbursement under this act, the municipality shall develop a form to be used for determining the financial status of inmates. The form shall provide for obtaining the age and marital status of an inmate, number and ages of children of an inmate, number and ages of other dependents, type and value of real estate, type and value of personal property, cash and bank accounts, type and value of investments, pensions and annuities, and any other personalty of significant cash value. The municipality shall use the form when investigating the financial status of inmates.