COVID19 Utility Assistance Program

COVID19 Utility Assistance Program

The City of Jacksonville recognizes that the COVID-19 Pandemic and the restrictions on public gatherings and closure of non-essential places of employment have created a financial hardship on our citizens. In response and with the support of HUD (US Dept of Housing & Urban Development), the City has established a COVID-19 Utility Assistance Program. It has been determined that there is a current need for our citizens to have access to assistance with City utility bills during this time. City residents meeting the qualifications listed below are encouraged to apply for one-time assistance. All applications will be reviewed by the City's Department of Neighborhood Improvement Services and relief provided based on their recommendation.. This is a needs-based financial assistance program for citizens who have been drastically impacted by COVID-19, because of reduced employment opportunities or COVID-19 illness. Awards are granted upon evaluation on a first-come, first-served basis. Application does not guarantee assistance. The City of Jacksonville is not responsible if receiving these funds precludes an individual from receiving funds from another source. ******PROCESSING TIME FOR THIS APPLICATION IS 7-10 DAYS******
Qualifications

Please ensure that the following qualifications are met before completing application. Certain documents will be required during application process. 1.Household meets low-moderate income qualification limits as defined by HUD (see below) One person $33,250; Two person $38,000; Three person $42,750; Four person $47,500; Five person $51,300; Six person $55,100 ; Seven person $58,900; Eight person $62,700. 2. Customer has experienced either a change in income or an illness directly related to COVID19. Do not proceed with application if both qualifications do not apply. ****THIS FUNDING IS FOR CITY RESIDENTS ONLY AND PROCESSING TIME IS 7-10 DAYS****
Name*

First Name Last Name
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number*

Area Code Phone Number
Email
example@example.com
Number of people in household*
Name, Relationship, Date of Birth, & Last Four of SS# for each household member
Have you received any other benefits from funding for the COVID19 crisis other than the recent stimulus funds from IRS such as FEMA, churches, non-profits, etc?*

YesNo
If you answered yes above, please list funds that you have received here and the purpose.
Unemployment Confirmation or Other Verification of COVID Related Hardship*

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Upload Unemployment Submission Confirmation Cancelof
Change in Employment Verification Letter

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Upload letter from employer verifying change in employment Cancelof
Household Income Documentation

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Upload two pay stubs or related document for pay periods after March 27, 2020 if still employed Cancelof
Please submit this application with the following applicable documents: Unemployment wage transcript, last paystub received, copy of child support order, and copy of social security documents.

I certify that the information I have provided to determine my eligibility for assistance through the City of Jacksonville’s Neighborhood Improvement Services is true and complete to the best of my knowledge. I understand that if the City discovers new information that indicates that I am not eligible for the program; my participation in the program could be canceled prior to program assistance approval. For the purpose of verification of information required by this application, I give my consent to the City of Jacksonville’s Neighborhood Improvement Services its agents and contractors to examine my confidential information given herein. I further grant permission, and authorize any bank, employer, credit bureau, or other public or private agency to disclose information deemed necessary to complete this application.

I certify and attest that the information is complete and accurate to the best of my knowledge. I certify that I have not received funding for utility assistance from another source. I understand that failure to provide complete and accurate information may be the basis for rejection of my application. My signature below attests that all information provided is accurate to the best of my knowledge.
Signature*

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COVID19 Utility Assistance Program

Qualifications