Disclaimer
Acknowledge
Notice - If ANY of following applies to YOU OR ANYONE in your household, then you MUST have all documentation in order to keep your utility appointment with Community Action Agency.
You must have:
- Original Social Security cards for everyone in your household.
- Current Photo ID of head of household including spouse, if applicable. Please check your ID expiration date.
- An Unpaid Current Original Power/Gas Bill. Note: Utility bills MUST be in head of household or spouse's name only. If in the Landlord's name you must provide rental agreement or letter.
- You MUST provide proof of Gross income for the PREVIOUS MONTH for ALL PERSONS living in the household this includes, but may not cover all types:
- Check stubs from employer, Social Security, SSI, pension, unemployment, and VA benefits. If you are a NACOLG employee our agency requires your income.
- Child support, TANF & Child Social Security/SSI benefits
- Any other income information you may have.
Declaration of Household Income Form: This form is to be completed by the person applying for assistance if any of the following situations apply to the applicant and/or household member age 18 and over for the previous month:
1. Had no income and verification cannot be obtained from a governmental entity such as DHR, DOL, Public Housing manager, etc.
2. Received income from occasional work such as lawn care, house cleaning, babysitting, car repair, etc. when a receipt book is not maintained.
3. Received money from family/friends.
4. Received income not reported elsewhere.
You may visit one of our offices to request a Declaration of Household Income form or visit our website at www.caanw.org to print it prior to your appointment.
- Non-parental guardians MUST PROVIDE documentation from the Court or Department of Human Resources showing current permanent or temporary custody of children living in the household.
- If you live in reduced income housing which includes, Public Housing, Section 8, or ANY income based housing you must bring your lease and housing choice voucher.
Notice - If ANY of following applies to YOU OR ANYONE in your household, then you MUST have all documentation in order to keep your utility appointment with Community Action Agency.
You must have:
- Original Social Security cards for everyone in your household.
- Current Photo ID of head of household including spouse, if applicable. Please check your ID expiration date.
- An Unpaid Current Original Power/Gas Bill. Note: Utility bills MUST be in head of household or spouse's name only. If in the Landlord's name you must provide rental agreement or letter.
- You MUST provide proof of Gross income for the PREVIOUS MONTH for ALL PERSONS living in the household this includes, but may not cover all types:
- Check stubs from employer, Social Security, SSI, pension, unemployment, and VA benefits. If you are a NACOLG employee our agency requires your income.
- Child support, TANF & Child Social Security/SSI benefits
- Any other income information you may have.
Declaration of Household Income Form: This form is to be completed by the person applying for assistance if any of the following situations apply to the applicant and/or household member age 18 and over for the previous month:
1. Had no income and verification cannot be obtained from a governmental entity such as DHR, DOL, Public Housing manager, etc.
2. Received income from occasional work such as lawn care, house cleaning, babysitting, car repair, etc. when a receipt book is not maintained.
3. Received money from family/friends.
4. Received income not reported elsewhere.
You may visit one of our offices to request a Declaration of Household Income form or visit our website at www.caanw.org to print it prior to your appointment.
- Non-parental guardians MUST PROVIDE documentation from the Court or Department of Human Resources showing current permanent or temporary custody of children living in the household.
- If you live in reduced income housing which includes, Public Housing, Section 8, or ANY income based housing you must bring your lease and housing choice voucher.