Resources for Independent Living TRUE Program Eligibility Requirements

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1 Household Size Minimum Annual Income Maximum Annual Income Resources for Independent Living TRUE Program Eligibility Requirements Applicants for the TRUE Energy Assistance must meet all of the following criteria:annual income per client household size must fall within the following range: 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, ) Demonstrate that gas and/or electric account is currently 45 days or more past due and/or have received a disconnection notice. 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. If you have not made these payments your application will be rejected. 3) Must not currently be receiving or have received any benefit through the USF and/or HEA programs within the last twelve months before the date of submitting a TRUE application. 4) 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! 5) 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. 6) Grants must guarantee continuation of services. You may be required to pay additional monies to your utility provider in order to maintain service. 7) We need GROSS income for all sources. (the amount before taxes are taken out).

2 TRUE APPLICATION REQUIRED DOCUMENTS **Please note that households who utilize municipal electric services will not be eligible for TRUE 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. 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!! 5. Clients that are not US citizens and do not have a SS card may still apply for TRUE 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. Sign and date the letter).

3 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 or a loops letter can be used as proof. You can obtain a loops letter from: 795 Woodlane Road, Westampton, NJ (609) Social Security Award letters from 2013 will now be required as there was an increase from last year. 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. 6. Child Support You must show proof of child support for all children in the household. You can obtain proof at 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. 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!

4 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. It needs to be stamped if 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! 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! Social Security cards for all members of the household Proof of residence (please see list of acceptable documents) Income documents (4 consecutive weeks for each member of the household, must include all sources of income regardless of what it is). Front Page of Gas Bill Front page of Electric Bill Drivers License for applicant 6 Month payment history with stamp from utility provider Please make sure the application is signed and completely filled out with all of the required documents attached when you come for your appointment. 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. 3. 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.

5 Last Name: First Name: Home Address: Soc. Sec. No: Home Phone: ( ) -- Cell Phone: ( ) -- 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. $

6 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

7 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 Social security cards Proof of residence Income documents Gas bill Electric bill Driver s license 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:

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