Emergency Financial Assistance Program

Applicant s Guide Application for Financial Assistance Emergency Financial Assistance Program A departmental employee can assist you if you have any difficulties understanding the program. You can also obtain help to complete the application for financial assistance if required. This guide is designed to help you submit an application under the Emergency Financial Assistance Program. It provides the general information that you need to understand the program terms and complete the attached application form. All of the information requested in the form is required for the study of your application for financial assistance. Purpose of the program The Emergency Financial Assistance Program is designed to provide financial assistance for people who find themselves in emergency situations, whose income is insufficient for them to support themselves and whose needs are not covered by any other government program. The financial assistance may be granted in a lump sum or as instalments during the program s period of application. Filing your application for financial assistance It is important to complete and sign your application for financial assistance as soon as possible while the program is in force and submit it to the office specified by the Ministère de l Emploi et de la Solidarité sociale. You can submit your application and the documents required to check your eligibility in person, by mail or by fax. The administrative unit that processes your application will contact you if necessary. Please be sure to indicate in your application the telephone numbers where you can be easily reached. If you are eligible for the program, you may be granted financial assistance as of the month in which the Ministère de l Emploi et de la Solidarité sociale receives your application. You will be sent a written notice of this decision. In order to receive the financial assistance to which you are entitled, you may have to go to a distribution centre. You will be provided with details about how to proceed, if applicable. For additional information about the program start and end dates, specific program eligibility conditions, amounts of financial assistance and terms of payment, or to find out where to submit your application, see our website (www.mess.gouv.qc.ca). You may also contact the Bureau des renseignements et plaintes by telephone (1-888-643-4721) to ask for information about the program. Page 1

Eligibility criteria An adult may be eligible for the program if he or she: is in an emergency situation for which the Ministère de l Emploi et de la Solidarité sociale is applying the program; meets the specific eligibility criteria; lives in Québec; and is a Canadian citizen within the meaning of the Citizenship Act, a person registered as an Indian within the meaning of the Indian Act, a permanent resident within the meaning of the Immigration and Refugee Protection Act or a person to whom asylum has been granted under the latter Act by the competent Canadian authority. The following adults may also be eligible for the program: Adults who have applied for asylum or who have been refused asylum but whose presence in the territory is permitted in accordance with the Immigration and Refugee Protection Act; Adults who are the subject of an application to become a permanent resident on humanitarian or public interest grounds made in accordance with the Immigration and Refugee Protection Act, who have been issued a selection certificate under the Act respecting immigration to Québec and whose is a Canadian citizen, a person registered as an Indian or a permanent resident; Adults who are the of a student; Adults who are required to reside in a half-way house and - are authorized to be temporarily absent from a correctional facility or a community correctional centre, - have been conditionally released, or - are accused persons required to live in a facility other than a penitentiary, a correctional facility or other prison. The following adults are not eligible for the program: Adults who are attending, within the meaning of the Individual and Family Assistance Regulation, a secondary-level educational institution in a vocational program on a full-time basis or a postsecondary educational institution, if they: - are enrolled in more than two courses or in courses giving more than six credits or units per term, - are enrolled in one or more courses giving credits or units corresponding to a total of more than six periods or hours of instruction per week, or - are registered for more than six credits or units per term for a master s or doctoral thesis; Adults who are enrolled in part-time studies but are deemed to be pursuing these studies on a full-time basis within the meaning of the Act respecting financial assistance for education expenses; Adults who are deemed to be enrolled in an educational institution by virtue of the Regulation respecting financial assistance for education expenses; Adults who are members of a religious community that has the means to provide for its members; Adults who are incarcerated in a penitentiary or detained in a correctional facility or any other prison, or are required to reside in a half-way house; Independent adults who are minors who are not fully emancipated; Adults who are covered by the Income Assistance Program administered by Indian and Northern Affairs Canada. Required documents The following documents must be provided for the, and dependent children. Identification documents If you were born in Canada: Canadian birth certificate. If you were born outside Canada, one of the following documents: Immigrant Visa and Record of Landing (IMM-1000); Confirmation of Permanent Residence (IMM-5292); Letter from the Immigration and Refugee Board of Canada confirming the status of refugee or person in need of protection; Claim for refugee protection; Authorization to enter Canada; and ID card with a photograph, for identification purposes only (health insurance card, driver s licence, passport, permanent resident card). No cards or copies will be kept in your file. Documents concerning your income If applicable, you must provide any documents required to determine your current income, including income that ends during the month of your application, as follows: Documents related to work income paycheque stubs, declaration of income from self-employment, proof of termination of employment; Documents related to income from government agencies employment insurance income, income from the Régie des rentes du Québec (RRQ), Québec Parental Insurance Plan benefits, compensation from the Commission de la santé et de la sécurité du travail (CSST), compensation from the Société de l assurance automobile du Québec (SAAQ), Canada Pension Plan income, etc.; Documents related to other income income from roomers or boarders, private pension income, support payments, real estate rental income, etc. Other documents Proof of residence in Québec deed of purchase, lease, property tax receipt, etc.; Proof of child custody judgment, agreement. Page 2

If you have a, dependent children or shared custody You must provide the Ministère de l Emploi et de la Solidarité sociale with full information about your and any dependent children who normally live with you. For the purposes of this application for financial assistance, the notions of, dependent child and shared custody are defined as follows: Spouse Your is: the person who lives with you, even if he or she is temporarily absent, and with whom you are married or in a civil union; the person who lives with you, even if he or she is temporarily absent, and who is the parent of at least one of your children; the person of full age, of the opposite or the same sex, who cohabits with you in a de facto union, even if he or she is temporarily absent, and who has, at some given time, lived with you for at least one year. Dependent child The following children are considered to be your dependants if you support them: a child under age 18, unless he or she is married or is the parent of a child who is his or her dependant; a child aged 18 or over who is a full-time or part-time student, unless he or she is married, is in a civil union, has a or is the parent of a child who is his or her dependant. The following children are not considered to be your dependants: a child who is sheltered in a rehabilitation centre or is in the care of a foster family or an intermediate resource, unless an intervention plan provides for the child s gradual reintegration into your family, or a child who is under tutorship by virtue of the Youth Protection Act; a child you had with a previous, if the former supports the child; a child for whom you have shared custody, if your share of custody time is less than 40%. Shared custody A parent is considered to have shared custody of a child if his or her share of custody time is 40% or more. Custody time is calculated on an annual basis and, to be considered to constitute 40%, it must amount to at least 146 days per year. Other program details Income such as the following is excluded from the calculation of financial assistance if it is received in installments: Benefits received under a last-resort financial assistance program or a specific program; Income that is fully excluded from the calculation of last-resort financial assistance, including: - child assistance payments from the Régie des rentes du Québec (RRQ), - Canada Child Tax Benefit amounts granted by the Canada Revenue Agency, - amounts earned by a dependent child, - amounts withdrawn from a registered education savings plan used by a dependent child as a student, - tax refunds and credits such as the work premium, - Universal Child Care Benefit amounts granted by the federal government. The income that is not excluded will be taken into account in calculating the financial assistance granted, following the application of a general exclusion of 300 per month. Liquid assets and the value of property are not taken into account for the purposes of the program. However, income generated by property is taken into consideration. The full amount of the financial assistance granted under the program is unassignable and unseizable. Your obligations 1. Use this form to file your application and provide any documents and information required to determine your eligibility and the amount of the emergency financial assistance. 2. Inform the Ministère de l Emploi et de la Solidarité sociale without delay of any change in your circumstances that could affect the amount of financial assistance granted. 3. If applicable, submit monthly statements on your circumstances by the specified deadline, using the form provided for this purpose by the Ministère de l Emploi et de la Solidarité sociale. 4. Exercise any rights and avail yourself of any benefits to which you are entitled under any legislation, if these rights and benefits affect your eligibility for the program or reduce the amount of your financial assistance. 5. Repay any amounts unduly received to the Ministère de l Emploi et de la Solidarité sociale. Failure to meet any of these obligations may lead to the refusal of your application, a reduction in the amount of financial assistance, the termination of your eligibility or a claim for repayment of the amounts granted. Page 3

Overpayments The recovery procedure set forth in Chapter II of Title III of the Individual and Family Assistance Act (sections 86, 97 to 101 and 103 to 106) applies to claims for repayment issued under this program. Recourse You may apply for administrative reconsideration of any decision rendered by virtue of this program within 30 days following the date on which you are notified of the decision. You must file your application in writing, using the form prescribed for this purpose, which you can obtain from a local employment centre (CLE). The form is also available on our website or by contacting the Bureau des renseignements et plaintes (see the bottom of this page). Administrative reconsideration decisions are final and may not be appealed. You may apply for a review of any claim for repayment issued under this program within 90 days following the date on which you are notified of the claim and, if you are dissatisfied with the review decision, file an appeal with the Tribunal administratif du Québec. You must file your application for review in writing, using the form prescribed for this purpose, which you can obtain from a CLE. Access to documents held by public bodies and the protection of personal information Access to your personal information is restricted to persons who are duly authorized by virtue of the Act respecting access to documents held by public bodies and the Protection of personal information (R.S.Q., c. A-2.1). You may ask to be informed about the information concerning you and, if applicable, request that the information be corrected. To do so, submit a written request to the local employment centre (CLE) or the departmental employee responsible for access to documents and the protection of personal information, whose contact information is posted on the our website (www.mess.gouv.qc.ca). More information For additional information, see our website (www.mess.gouv.qc.ca) or contact the Bureau des renseignements et plaintes at 1-888-643-4721. Page 4

Application for Financial Assistance Emergency Financial Assistance Program Date de réception de la demande SECTION FOR DEPARTMENTAL USE ONLY Authentification Numéro de dossier : Date : Signature : Section 1 Emergency situation covered by the application Describe the emergency situation. Section 2 Identification Social insurance number Applicant Social insurance number Spouse Marital status Specify period of cohabitation. Single Married/Civil union De facto From: to Widowed Separated/Divorced You or your are (if applicable): a member of a religious community incarcerated or obliged to reside in an establishment represented by the Curateur public du Québec a student (indicate the level): secondary general secondary vocational college or university other (specify): Number of courses Number of hours or periods per week Number of credits or units Dependent children (see the definitions of dependent child and shared custody ) Child 1 Do you share custody of this child with another person? Yes No If Yes, indicate the number of days you have custody of the child: per year Child 2 Do you share custody of this child with another person? Yes No If Yes, indicate the number of days you have custody of the child: per year Child 3 Do you share custody of this child with another person? Yes No If Yes, indicate the number of days you have custody of the child: per year continued on other side Ministère de l Emploi et de la Solidarité sociale SR-2551A (01-2010)

Section 3 Home address Number Municipality Street Apartment Postal code Telephone (home) Other (emergencies) Person to contact in the event of an emergency Last name and first name Telephone Section 4 Income Do you or your receive income (employment income, CSST or SAAQ compensation, support income, etc.)? Yes No If Yes, please specify: Source Source Source Do you or your expect to receive any income, earnings or benefits (insurance payments, annuities, severance pay, etc.)? Yes No If Yes, please specify: Section 5 Additional information (Use this section to enter any additional information.) Section 6 Solemn declaration I solemnly declare that the information provided in this application form is true and complete, and I agree to inform the Ministère de l Emploi et de la Solidarité sociale without delay of any change in this information. I have read the information guide and agree to meet my obligations as shown on page 3 of this application form. Date Signature of Date Signature of