Resources for Independent Living TRUE/PAGE Program Eligibility Requirements

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1 Resources for Independent Living TRUE/PAGE Program Eligibility Requirements Applicants for the TRUE/PAGE Energy Assistance must meet all of the following criteria: Annual income per client household size must fall within the following range: Household Size Minimum Annual Income Maximum Annual Income 1 Person 2 Person 3 Person 4 Person 5 Person 6 Person 7 Person 8 Person 9 Person $22,992 $31,032 $39,072 $47,112 $55,152 $63,192 $71,232 $79,272 $87,312 $54,003 $70,618 $87,235 $103,852 $120,468 $137,085 $140,200 $143,317 $146,432 Income Guidelines as of October 1, 2013 TRUE PROGRAM REQUIREMENTS 1. Demonstrate that gas and/or electric account is currently 45 days or more past due and/or service has already been disconnected. 2. Demonstrate that 4 payments of at least $25 each have been made within the past 6 months onto the gas and electric account. At least 3 of those payments should have been made 30 days prior to the date of application. PAGE PROGRAM REQUIREMENTS 1. Demonstrate that gas and/or electric account is currently 45 days or more past due and/or service has already been disconnected. 2. Demonstarte that 2 payments of at least $25 or more each have been made withint the past 6 months onto the gas and electric accounts. At least 1 of those payments should have ben made 30 days prior to the date of application OR a $100 good faith payment has been made to EACH utility within the past 90 days ($200 if you have a gas and electric combined account) 3. Must not currently be applying for, receiving or have received any benefit through the USF and/or HEA (LIHEAP) programs within the last twelve months before the date of submitting a TRUE application. 3. Must not currently be applying for, recieiving or have received any benefit through the LIHEAP (HEA) programs within the current heating season. Must not currently be receiving or have received a USF benefit within the past 6 months. Please note, that by filling out this application you are applying for both the PAGE and TRUE programs. However, you will only be eligible to recieve a grant from one program at a time. Resources for Independent Living, Inc. will screen your application to determine which program you may be qualified for at this time. 1. All required documentation must be provided with the completed application. Any applications that are missing any required documentation will NOT be processed. In addition, all of your documentation must be current. If your documentation is not current your application will be returned to you. THERE ARE NO EXCEPTIONS!

2 2. You must make an appointment with a Utility Assistance Specialist. We do not accept faxes, s, mail delivery or drop-ins. Cases are taken on a first come, first serve basis. There are no exceptions to this rule. 3. We will not provide letters or call your utility provider stating you have applied for the program. Application to the program does not guarantee funding. 4. Grants must guarantee continuation of services. You may be required to pay additional monies to your utility provider in order to maintain service. 5. We need GROSS income for all sources. (the amount before taxes are taken out). TRUE/PAGE APPLICATION REQUIRED DOCUMENTS **Please note that households who utilize municipal electric services will not be eligible for TRUE/PAGE program benefits** Please complete this application in its entirety and provide COPIES of the following documentation. PLEASE PRINT, NO CURSIVE HAND WRITING! If you skip a question this application will be returned to you and not processed. A.Driver s License 1. The driver s license must be of the primary applicant and MUST have the current address listed on it. The address on your license has to match the address that you are applying for assistance with. If your license does not match your address you can go the DMV website and change it for free. We accept the DMV printout as proof. In addition we will accept the sticker from the DMV that is placed on the back of your license. 2. If you do not have a license you can show proof of a NJ State or NJ County ID with your address on it. 3. If you have ITIN only and cannot receive a county ID, please contact us to see what else may be acceptable. 4. WE CANNOT ACCEPT A PASSPORT, MILITARY ID OR PERMENANT RESIDENT CARD IN PLACE OF A LICENSE. THERE ARE NO EXCEPTIONS! B. Social Security Cards Copies of social security cards must be presented for all members of your household. The card must be legible; we cannot accept darkened cards where the numbers cannot be read. We will accept the following in place of social security card: 1. Letter from the social security office stating this number belongs to. You can go to the local office in Mt. Holly to obtain proof UNTIL APRIL BEYOND THAT DATE YOU WILL HAVE TO CONTACT SOCIAL SECURITY. 2. Current military ID that shows the client s name and social. 3. Medicare/Medicaid card that shows the clients name and social security number. 4. WE CANNOT ACCEPT A TAX RETURN IN PLACE OF SS CARDS, EVEN THOUGH IT IS A REQUIRED DOCUMENT!!

3 5. Clients that are not US citizens and do not have a SS card may still apply for TRUE/PAGE as long as one person in the household has a Social Security number. We can accept their tax ID card/letter if they possess one. C. Income Everyone in the household over the age of 18 must provide income! If anyone in the household 18 or older who has no income you must provide a zero income statement. (The letter should state: I have zero income. Signed by that person and letter must be dated). 1. Employment - Pay stubs can only be accepted up to 60 days prior from the completed date of the application. For example, if you apply in September but do not complete the application until January, we cannot use the September pay stubs. All pay stubs must show 4 consecutive weeks of income. 2. Unemployment - We do not accept the initial determination of unemployment as proof that someone is receiving current unemployment. This determination only shows what they may be eligible for. We need to make sure that you are currently receiving unemployment and that they are not receiving other earnings with it. A current print of from the unemployment website from your account or a loops letter can be used as proof. You can obtain a loops letter from: 795 Woodlane Road, Westampton, NJ (609) Social Security The most current year s award letter must be provided. You must show proof of social security if a minor child is receiving an award. 4. Business Income - Your schedule C Profit and Loss statement from your tax return (most recent year). For this instance only we look at line 31, net profits or Loss as your income. 5. Rental Income A rental income statement is required from your most recent tax return. The net amount will be used as the amount of income. Please provide Schedule E fom previous year s tax return showing profit/loss. 6. Child Support You must show proof of child support for all children in the household. You can obtain proof at 7. Pension You must provide a letter or a statement dated within the last two months stating your gross montly amount. *Bank statements and copies of checks are not accepted as proof of income as we must take the gross amount. Pension, child support, family contribution, TANF and GA are all considered sources of income and documentation must be provided. If you do not receive statements regularly from your source of income you must contact them to obtain proof. THERE ARE NO EXCEPTIONS PLEASE DO NOT ASK! D. Proof of Residence 1. If you own a home please provide a copy of your deed, property tax statement or mortgage statement. It must be current and show property address.

4 2. If you rent, please provide a copy of your lease. If you do not have one, a letter from the landlord indicating the address and occupancy status must be submitted, this letter must be signed and dated with contact information for the landlord. Your lease must be current with lease start and end dates, address of property, and signatures of both the tenant and landlord. We cannot accept copies of checks, money orders, the bottom half of a payment coupon or outdated information! E. Payment History We need the following, no exceptions! Please read this carefully, there are two separated pieces of documentation that are required below! 1. You must go to your utility provider and obtain a 6 month printout of your billing statement for each utility company you may have. It needs to be stamped if your utility company is PSE&G. If it is not stamped we will not accept it. WE WILL NOT ACCEPT A PRINTOUT FROM YOUR ONLINE ACCOUNT! You can obtain a printout from the PSE&G office on High Street in Burlington City, NJ. 2. We also need a copy of the front page of your most recent electric bill and gas bill with your current address. WE DO NOT WANT 6 MONTHS OF BILLS! F. Tax Returns 1. First two pages (ex first page of form 1040, 1040 a etc) and signature page of tax return for previous year. Tax return MUST be signed if it is self prepared. If it is prepared by a tax specialist, the bottom part must be filled out with specialist name and pin 2. If the client has rental income they MUST provide a Schedule E. 3. If the client has a business profit or loss, MUST provide a Schedule C 4. If the client has more or less dependents listed on their tax return than what they have listed on the TRUE/PAGE application, they MUST provide proof of residence for the individual or individuals in the form of a current Driver s License or lease. School document showing the address where they are registered (if under 18) 5. If the client has IRA distributions (line 15a) and is of retirement age and their IRA is $10,000 or over it will count as assets as it can be withdrawn and they are disqualified. We will need a current statement if that is the case to determine eligibility. 6. If the client has pensions/annuities (line 16a) and DID NOT provide a current pension statement, they must provide their 1099 front and back so we can determine if it was a onetime withdrawl. NON FILERS a. Clients with pensions and social security as their only form of income, are not required to file taxes. If they state that they did not file, they must provide a letter from the IRS that verifies they did not file.

5 b. If a client claims that they had zero income the previous year and did not file, they will need to provide the non filing letter and a signed and dated statement which states that they had zero income for the previous filing year. c. Clients who provide pay stubs or other earned income are required to file taxes. If they state that they have not filed, they will need to file and provide us with the copy of the return in order for us to process the file. * Please note: Additional documents may need to be requested once your application is reviewed. *We cannot accept utility bills that are billed though your apartment complex management. We cannot accept utility bills from a municipal authority. Please use the documentation checklist to ensure you have all your documentation before you bring your application to us! Drivers License for applicant Social Security cards for all members of the household Income documents (4 consecutive weeks for each member of the household, must include all sources of income regardless of what it is for all members of the household). Zero income letter (if applicable for individuals over 18 that have no income only) Proof of residence (please see list of acceptable documents) 6 Month payment history with stamp from utility provider Front Page of Gas Bill Front page of Electric Bill Tax return first page and signature page for everyone over 18 Additional documents if applicable Please make sure the application is signed and completely filled out with all of the required documents attached when you come for your appointment. Incomplete applications will not be processed. If you do not have all your documentation at the time of your appointment we will return everything to you. We cannot hold your documents if the package is not complete. 1. Once your application is completed please call our office to make an appointment at (609) You must be on time for your appointment. If you miss your appointment time you will have to reschedule for the next available appointment. 2. All documents are required at the time of your appointment. If you do not have the required documentation your entire application and backup will be returned to you and you will have to reschedule your appointment for a later date. Absolutely no applications can be mailed, faxed, scanned/ ed or dropped off in person. Incomplete applications will NOT be processed.

6 TRUE/PAGE ENERGY ASSISTANCE APPLICATION Last Name: Soc. Sec. No: First Name: Home Phone: ( ) -- Cell Phone: ( ) -- Home Address: Address Line 2/ PO Box or Apt. No.: County: City: State: ZIP: Household Members: First Name, Middle Initial and Last Name of everyone who resides in household including applicant Social Security # of everyone who resides in the household including applicant Date of Birth Relationship to Applicant Household Income: Name of Income Earner Gross Amount Pay Cycle (weekly, biweekly, etc.) 1. $ 2. $ 3. $ 4. $ 5. $ 6. $ 7. $ 8. $

7 Sources of Income: (check all applicable) Employment Unemployment Child Support Alimony Worker s Comp. Disability Social Security Family Contributions Other (specify): Do you have any assets other than a home that totals more than $10,000? Savings CDs Money Market Stocks/Bonds Check here if your utility service is currently disconnected: Natural Gas Electric What is your temporary emergency? (check all applicable) Job Loss Medical High Energy Cost Loss of Income Other (specify): Assistance Type: Natural Gas Electric Natural Gas and Electric Name of Electric Company: JCP&L PSE&G Rockland Electric NJNG PSE&G Elizabeth Gas Atlantic City Electric South Jersey Gas Other: Account #: Past Due Status: 45 days 60 days 90 days Disconnection notice Name of Natural Gas Company: JCP&L PSE&G Rockland Electric NJNG PSE&G Elizabeth Gas Atlantic City Electric South Jersey Gas Other: Account #: Past Due Status: 45 days 60 days 90 days Disconnection notice Race: * This is voluntary information. It is compiled and recorded for statistical purposes only. White/Caucasian Black/African American Hispanic-Latino Asian American Indian/Alaskan Native Pacific Islander More than one race Other If you are a person with any type of disability (regardless if you are receiving social security) please ask us about our other services that are available to you for free! If you are unsure please ask to speak with an Independent Living Specialist today! If you are a person with a disability or have a family member with a disability and you would like additional information about our free services please check here and we will have a staff person follow up with you.

8 By signing this application, I certify under oath that the information given in and attached to this application is true, complete and correct. I am aware and understand that if any information contained in or attached to this application is willfully false, that I am subject to criminal prosecution under N.J.S.A. Section 2C:28-2. I understand that I must provide the required documentation in order to proceed with the application process. I understand and acknowledge that additional documentation may be needed to determine or confirm my household s eligibility for assistance. I agree to cooperate with any reasonable requests to provide information and understand if such information is not provided it may result in the termination or suspension of my application. By signing this application, I authorize the Affordable Housing Alliance and/or its affiliate agencies to (1) contact my household s current utility provider on my behalf to arrange or attempt to arrange an assistance payment on my account, and (2) verify any information contained in or attached to this application. Signature: Date: OFFICE USE ONLY Document Checklist Drivers License Social Security cards Income documents Proof of residence 6 Month payment history Front Page of Gas Bill Front page of Electric Bill Tax return first and signature page Additional Documents Process Status Verified Non LIHEAP/USF Status (date: ) Verified Income Calculations (gross monthly amount $ ) Verified Utility Bill Payments (4 of 6 months) Applicant Account 45 days past due or shut off notice issued Approved (Amount $ Gas Electric Both ) Denied (Reason: ) Date Process Completed: