Required Documents

Sign and Comply with an Acknowledgment and Consent Statement

• Authorizes the Program to obtain third-party data directly related to determining the award amount and/or compliance with Program requirements
• Applicant grants subrogation rights to the Program regarding the right to recover any funds that are duplicated with other sources of assistance
• Applicant attests to losing household income as a result of COVID-19 (layoff, reduction of hours, business closed, required to quarantine, caring for school-aged children, etc) or has experienced a large, unexpected medical cost related to COVID-19, now resulting in a gap in income

Form of Picture Identification

Verification of all sources of income and assets

• Last 30 calendar days of pay stubs for all adults age 18 and older, pension statement(s), social security award letter(s); and/or any documentation of any household income, this includes, but is not limit limited to the following documentation listed below.
  • Federal / State Tax Returns
  • Employer Letter
  • Unemployment Letter
  • Self-Employment Certification Form (to be submitted if the applicant is self-employed)
• The Applicant should provide the documentation that is most representative of their current income during and post COVID-19. For example, if an Applicant made less money due to COVID-19, check stubs or an unemployment letter would be representative than a 2018 or 2019 tax return.
• Utility Bill(s) for the last two months or Bill Statement which captures this information.
  • Utilities that are eligible for this Program are as follows: natural gas, electricity, water, sewage and internet
• Past Due utility bills or statements. 
  • If applying for utility arrears (past due utilities), households may apply for up to 4 months of assistance

Any additional information deemed necessary to verify eligibility or determine the unmet need for the Program