CONTRACT RE URRD PROGRAM AND HEAT RELIEF WITH WILDFIRE.PDF
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INDEPENDENT CONTRACTOR AGREEMENT
2024-25 Utility Assistance Programs
Contract No. 07012024-25
This INDEPENDENT CONTRACTOR AGREEMENT (this "Agreement") is entered into as of the
Effective Date set forth below by and between Maricopa County (hereinafter "Contractor") and Arizona
Community Action Association, an Arizona nonprofit corporation DBA Wildfire (hereinafter "Wildfire").
RECITALS:
A. Wildfire is a nonprofit organization that, as part of its mission to promote economic self-sufficiency for
low-income Arizonans, administers energy program funding to provide weatherization services, utility
repair and replacement, utility deposits and bill assistance.
B. Wildfire is receiving or expects to receive during the term of this Agreement funding from the fund
sources in Section 1 (the "Fund Sources") pursuant to Program Documents (as defined in Section 4).
C. Wildfire desires to subcontract with Contractor to obtain assistance with fulfilling Wildfire’s obligations
under the Program Documents and Contractor desires to receive the funding described herein and use it to
provide services in accordance with the Program Documents and this Agreement.
THEREFORE, in consideration of the terms and conditions set forth in this Agreement and intending to be
bound, Wildfire and Contractor hereby agree as follows:
1. Services and Programs
1.1 Services. Contractor agrees, under the terms and conditions of this Agreement, to perform the
following services for the programs listed in Section 1.2: (i) conduct application intake services, (ii) make
eligibility determinations, and (iii) where applicable, conduct weatherization work, utility deposits, repair and
replacement work, and (iv) bill assistance. Contractor shall perform the foregoing services during the term
set forth in Section 2. Wildfire will not exercise control over the specific methods used by Contractor or
the specific manner in which Contractor performs services under this Agreement, but Contractor shall
follow Wildfire's instructions as to the result to be achieved. Contractor will receive Wildfire’s instructions
through an employee of Wildfire who is appointed to manage the program (“Program Manager”).
Contractor may also receive instructions from a Wildfire employee designated to serve as a liaison
between Wildfire and Contractor (“Monitor”).
1.2. Fund Sources. For purposes of this Agreement, the programs, Fund Sources and amount of funding
to be allocated to Contractor will be as set forth in the table on the following pages.
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1.2 Fund Sources
Fund
Direct Service
Amount
Program
Delivery
Amount
Total
Allocation
Additional Information
APS Crisis Bill
Assistance
$0.00
$0.00
Refer to Exhibit A: Arizona
Public Service (APS) Crisis
Bill Assistance Program
Summary
Global Water Bill
Assistance
$0.00
$0.00
Refer to Exhibit A: Global
Water Bill Assistance
Program Summary
Salt River Project (SRP)
Bill Assistance
$0.00
$0.00
Refer to Exhibit A: Salt River
Project (SRP) Bill Assistance
Program Summary
Southwest Gas Energy
Share Bill Assistance
$0.00
$0.00
Refer to Exhibit A:
Southwest Gas Energy Share
– Bill Assistance Program
Summary
Southwest Energy Share
Repair/Replace
$0.00
$0.00
Refer to Exhibit A:
Southwest Gas Energy Share
Repair/Replace Program
Summary
Southwest Gas Low
Income Energy
Conservation (LIEC)
$0.00
$0.00
Refer to Exhibit A: SWG
LIEC Program Summary.
These funds should be
prioritized for distribution over
SWG E-Share funds for all
eligible clients. No more than
twenty-five percent (25%) of
total allocation can be used
for deposits.
Trico
$0.00
$0.00
Refer to Exhibit A: Trico
Assistance Program
Summary
Tucson Electric Power
(TEP) Bill Assistance
$0.00
$0.00
Refer to Exhibit A: Tucson
Electric Power Bill Assistance
Summary
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1.2 Fund Sources (Continued)
Fund
Direct Service
Amount
Program
Delivery
Amount
Total
Allocation
Additional Information
Utility Repair
Replacement Deposit
(URRD)
$202,825.00
$40,565.00
$243,390.00
Refer to Exhibit A: URRD
Program Summary. Refer to
Exhibit A, Appendix B:
Instructions for Verifying
Citizenship and Non-Legal
Permanent Resident (LPR)
Status.
20% of URRD allocation
above is available for
HVAC Pilot Program
$40,565.00
$8,113.00
$48,678.00
Refer to Exhibit A: URRD
Program Summary
Unisource Electric Bill
Assistance
$0.00
$0.00
Refer to Exhibit A: Unisource
Electric Bill Assistance
Program Summary
Warm Spirit Electric - Bill
Assistance
$0.00
$0.00
Refer to Exhibit A: Warm
Spirit Program Summary
Warm Spirit Gas - Bill
Assistance
$0.00
$0.00
Refer to Exhibit A: Warm
Spirit Program Summary
Heat Relief Initiative
$70,016.67
$14,003.33
$84,020.00
Refer to Exhibit A: Heat
Relief Initiative Program
Summary
Heat Relief Initiative --
Minimum amount of Direct Service Allocation that must be expended in APS territory: $30,000.00
Heat Relief Initiative --
Minimum amount of Direct Service Allocation that must be expended in SRP territory: $40,000.00
Heat Relief Initiative --
Minimum number of households that must be served in order to exceed $10,000 household limit: 7
(see Exhibit A: Heat Relief Initiative Program Summary)
1.2. Fund Sources (Continued). Contractor makes guarantees and payments to utility companies and
repair/replacement vendors. Service costs and program delivery costs are then reimbursed based on
activity reports.
The table above, which highlights certain provisions of the Program Documents, is provided for
Contractor’s convenience and is not intended to be an exhaustive description of all material terms of the
Program Documents. Contractor is advised to carefully review the Program Documents in their entirety. In
the event of any conflict between this summary and the Program Documents, the terms of the Program
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Documents will control.
1.3 Training. Contractor will participate in any training provided by Wildfire on dates and times selected
by Wildfire.
1.4 Program Modification. Wildfire and the Fund Sources reserve the right to modify program eligibility
guidelines and Program Documents. Contractor agrees to implement and comply with any and all
modifications immediately after receipt of written notice of such modifications.
2. Term and Termination.
2.1 Term. Unless sooner terminated pursuant to Section 2.2, the term of this Agreement will be for one
year beginning on the later of full execution of this Agreement or July 1, 2024 (the “Effective Date”) and
ending on June 30, 2025.
2.2 Termination. Either Wildfire or Contractor may terminate this Agreement at any time, for any or no
reason, by giving thirty (30) days written notice to the other party of its election to terminate. If a Fund
Source terminates a program or otherwise discontinues funding to Wildfire, then this Agreement will
automatically terminate as to any services to be provided for that Fund Source.
2.3 Effect of Termination; Survival. Upon termination, Contractor's obligation to perform further services
for Wildfire shall terminate and Wildfire's obligation to provide funding to Contractor for such services shall
terminate, but the remainder of this Agreement shall continue in full force and effect.
3. Funding; Expenses; Nature of Relationship.
3.1 Funding; Payments to Contractor. Not later than the 15th day of each month, Contractor will ensure
that all services performed during the prior month are represented correctly in the Wildfire Grants
Management System (GMS) as required by Section 4. After the 15th day of each month, Wildfire will
endeavor to review Contractor’s activities from the prior month and give notice to Contractor of any
disallowed items within ten (10) business days. Wildfire will submit all approved portions of Contractor’s
activities to the applicable Fund Sources. Contractor acknowledges and agrees that all activities are
subject to approval by the Fund Sources and Wildfire’s approval does not bind any Fund Source or
constitute a guarantee by Wildfire of payment to Contractor.
3.2 Request for Additional Funds. Contractor may submit in writing a request for additional funds to
Wildfire no earlier than November 30 of the current contract year. Requests for additional funds will be
submitted to the Home Energy Assistance Fund Advisory Board of Directors on the next available agenda.
Approval of request(s) will be based on: a) there are adequate funds available; b) agency is at an
expenditure rate to ensure any additional funds will be expended; c) request is not being used to cover
over expenditures. All approved requests will be submitted to the Wildfire Board of Directors on the next
available agenda for final review and approval.
3.3 Reimbursement of Expenses. Wildfire may provide certain materials and supplies to Contractor for
use in performing services under this Agreement. Except for such materials and supplies, and except to
the extent the Program Documents permit reimbursement of expenses from the Fund Sources, Contractor
shall be responsible for expenses that it incurs in performing services under this Agreement, and shall not
be entitled to reimbursement from Wildfire.
3.4 Expenditures. Wildfire reserves the right to terminate, reduce, or reallocate funds to another
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Contractor within the service territory, if Contractor’s expenditure rate is not at a percentage to ensure one
hundred percent expenditure of funds within the contract period. Wildfire will conduct a review of agency
expenditures on a quarterly basis, and will notify the Contractor of any concerns. It is the responsibility of
the Contractor to monitor all contract expenditures and to ensure that no over expenditures occur. If an
over expenditure occurs, the Contractor is responsible for absorbing and/or returning the amount of the
payment.
3.5 Advance Payments. Contractor may request a one-time advance in accordance with the established
One-Time Advance Payment Policy approved by the Home Energy Assistance Advisory Board of Directors
and the Wildfire Board of Directors. Contractor may request the Advance Request Form through Wildfire,
if needed.
3.6 Nature of Relationship. As between Wildfire and Contractor, Wildfire shall have the same rights as
the Funding Sources have under the applicable Program Documents. Contractor shall have only those
rights expressly provided to Contractor under this Agreement. The relationship between Wildfire and
Contractor shall be that of independent contractors for purposes including tax law purposes and
employment law purposes and not that of employer-employee, partners, joint ventures, or otherwise.
Contractor acknowledges and agrees that Contractor shall have no right or opportunity to participate in any
employee benefits plans, compensation plans, or other benefits that Wildfire may offer to its employees,
and that Contractor will not be treated as an employee for purposes of workers compensation laws,
employment laws, or tax laws, including without limitation federal and state income tax laws, social security
tax laws and unemployment contribution laws. Contractor agrees to comply with all laws applicable to
independent contractors including, but not limited to, professional and tax licensing requirements and
reporting and payment of applicable federal, state and local taxes, including without limitation income taxes
and self-employment taxes.
3.7 Indemnification. Each Party (as "indemnitor") agrees to indemnify, defend, and hold harmless the
other Party (as "indemnitee") from and against any and all claims, losses, liability, costs, or expenses
(including reasonable attorney's fees) (hereinafter collectively referred to as "claims") arising out of the
negligent performance of this Agreement, but only to the extent that such claims which result in
vicarious/derivative liability to the indemnitee are caused by the act, omission, negligence, misconduct, or
other fault of the indemnitor, its officers, officials, agents, employees, or volunteers.
3.8 Insurance.
3.8.1 Contractor and any subcontractors shall procure and maintain, until all of their obligations
have been satisfied, insurance against claims for injury to persons or damage to property which
may arise from or in connection with the performance of the services hereunder by Contractor or
Contractor’s agents, representatives, employees or subcontractors. Contractor shall also procure
and maintain all additional insurance coverage required by the Program Documents.
3.8.2 The insurance requirements herein are minimum requirements for this Agreement and in
no way limit Contractor’s indemnity obligations contained in this Agreement. Wildfire makes no
representation or warranty that the minimum limits contained herein are sufficient to protect
Contractor from liabilities that might arise out of the performance of the work under this contract by
Contractor, its agents, representatives, employees or subcontractors, and Contractor is free to
purchase additional insurance.
3.8.3 Contractor shall provide coverage with limits of liability not less than those stated below.
o
a) Commercial General Liability – Occurrence Form
General Aggregate: The policy will have a combined single limit of $2,000,000 for
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each occurrence for bodily injury and property damage. The policy shall include
bodily injury, property damage, personal injury and broad form contractual liability.
The policy shall be endorsed to include the following additional insured
language: “Arizona Community Action Association (dba Wildfire) shall be named as
additional insured with respect to liability arising out of the activities performed by or
on behalf of the Contractor".
The policy shall contain a waiver of subrogation against Arizona Community Action
Association (dba Wildfire) and its officers, officials, agents, and employees for
losses arising from work performed by or on behalf of the Contractor.
o
b) Automobile Liability
Bodily Injury and Property Damage for any owned, hired, and/or non-owned
vehicles used in the performance of this Agreement.
Combined Single Limit (CSL) $ 1,000,000
The policy shall be endorsed to include the following additional insured
language: “Arizona Community Action Association DBA Wildfire shall be
named as additional insured with respect to liability arising out of the
activities performed by or on behalf of the Contractor, involving automobiles
owned, leased, hired or borrowed by the Contractor".
o
c) Worker's Compensation and Employers' Liability
The policy will cover all obligations imposed by federal, state and local statutes with
jurisdiction over Contractor’s employees.
The policy shall contain a waiver of subrogation against Arizona Community Action
Association (dba Wildfire) and its officers, officials, agents, and employees for
losses arising from work performed by or on behalf of the Contractor.
3.8.4 Wherever additional insured status is required, such additional insured shall be covered to
the full limits of liability purchased by the Contractor, even if those limits of liability are in excess of
those required by this Agreement. The Contractor's insurance coverage shall be primary insurance
with respect to all other available sources. Coverage provided by the Contractor shall not be
limited to the liability assumed under the indemnification provisions of this Agreement.
3.8.5 Each insurance policy required by the insurance provisions of this Agreement shall provide
the required coverage and shall not be suspended, voided, canceled, or reduced in coverage or in
limits except after thirty (30) days prior written notice has been given to Wildfire.
3.8.6 Insurance is to be placed with duly licensed or approved non-admitted insurers in the state
of Arizona with an “A.M. Best” rating of not less than A- VII. Wildfire makes no representation or
warranty that the above-required minimum insurer rating is sufficient to protect Contractor from
potential insurer insolvency. If Contractor utilizes the Social Service Contractors Indemnity Pool
(SSCIP) or other approved insurance pool for insurance coverage, SSCIP or the other approved
insurance pool is exempt from the A.M. Best’s rating requirements listed in this Agreement. If
Contractor chooses to use SSCIP or another approved insurance pool as its insurance provider,
Contractor would be considered in full compliance with insurance requirements relating to the A.M.
Best rating requirements.
3.8.7 Contractor shall furnish Wildfire with certificates of insurance (ACORD form or equivalent
approved by Wildfire) as required by this Agreement. The certificates for each insurance policy are
to be signed by a person authorized by that insurer to bind coverage on its behalf. All certificates
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and endorsements are to be received and approved by Wildfire before services commence. Each
insurance policy required by this Agreement must be in effect at or prior to commencement of
services under this Agreement and remain in effect for the duration of the term of this Agreement.
Failure to maintain the insurance policies as required by this Agreement, or to provide evidence of
renewal, is a material breach of contract.
3.8.8 Contractor’s certificate(s) shall include all subcontractors as insureds under its policies or
Contractor shall furnish to Wildfire separate certificates and endorsements for each subcontractor.
All coverages for subcontractors shall be subject to the minimum requirements identified above.
3.8.9 In the event the Contractor is a public entity, then the insurance requirements shall not
apply. Such public entity, during the term of this Agreement, shall maintain liability insurance or
self-insurance coverage for the negligent acts, errors and omissions of its officers, officials,
agents, employees or volunteers. Contractor shall furnish Wildfire with evidence of its self-insured
policy by submitting a certificate of insurance. Contractor shall maintain insurance policies for the
duration of the term of this Agreement.
4. Compliance with Terms of Funding.
4.1 Contractor’s Compliance with Terms of Funding. Contractor acknowledges that Contractor’s services
will be part of the programs funded by the Funding Sources in Section 1 pursuant to the Program
Documents. Contractor agrees it will be bound by and will comply with all terms and conditions of the
Program Documents, including without limitation all indemnification and insurance obligations. The
“Program Documents” consist of the Attachments and Exhibits hereto and any written policies and
procedures that Wildfire may send to Contractor from time to time, all of which are incorporated herein by
this reference. The Program Documents require Wildfire to submit certain periodic reports to the Fund
Sources. Contractor agrees to cooperate with Wildfire in preparing these reports. In addition, Contractor
agrees to comply with all other reporting obligations under the Program Documents.
4.2 Grants Management System Database (GMS). Contractor will ensure that applications from all fund
sources will be directly entered into the GMS Database, or transferred electronically, in accordance with
the policies outlined in the Program Documents.
5. Confidential Information.
5.1 Contractor's Obligation of Confidentiality. Contractor recognizes that as a result of this Agreement
and Contractor’s performance of services hereunder Contractor will have access to confidential information
(“Confidential Information”). Contractor will keep the Confidential Information it receives confidential at all
times and will not, without the prior written consent of Wildfire, disclose Confidential Information to any
person other than its legal counsel and other parties authorized by Wildfire in writing prior to the disclosure
of the Confidential Information (such legal counsel and other authorized parties will hereinafter be
collectively referred to herein as the "Representatives") who need to know the Confidential Information.
Contractor agrees to inform its Representatives of the confidential nature of the Confidential Information
and to obtain their agreement to be bound by the terms of this Section 5 for the benefit of Wildfire.
Contractor agrees to treat and use Confidential Information in a manner that is consistent with protecting
such information. Contractor agrees that it will be responsible for any unauthorized use or disclosure of
Confidential Information or other non-compliance with this Agreement by any Representative or other
agents, or by any other person who obtains access to Confidential Information from, or due to the fault of,
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Contractor. Any such non-compliance will constitute a breach of this Agreement by Contractor.
5.2 Definition of Confidential Information. Confidential Information includes without limitation any
information in whatever form, whether documents, computer disks, computer drives, computer chips, audio
tapes or video tapes, that are marked with the legend "confidential" or other notice of similar meaning or
are otherwise treated as confidential by Wildfire. Whether or not indicated to be confidential, the following
information shall be deemed to constitute Confidential Information: all data collected from applicants for
assistance and program participants including without limitation names, addresses, and any other
information of a personal or intimate nature, and all trade secrets, proprietary data, financial information,
business information and other proprietary information disclosed by Wildfire to Contractor, and further
including without limitation any copies, summaries, indexes or abstracts of Confidential Information and
any information or materials derived from Confidential Information. In addition to the foregoing, any
information that is otherwise protected by law as confidential without regard to this Agreement shall
constitute Confidential Information. The term "Confidential Information" as used herein does not include
any information which (a) is already known to the public prior to disclosure to Contractor; (b) is
subsequently made known to the public without any violation of this Agreement; or (c) is rightfully received
by Contractor from a third party without similar restriction and without breach of this Agreement.
Notwithstanding the foregoing, Contractor will not be deemed in violation of this Agreement in the event
Contractor discloses Confidential Information in response to a duly issued court order or subpoena if
Contractor provides prompt advance notice thereof to Wildfire or if Contractor discloses data regarding
applicants for assistance and program participants to the extent required by Contractor’s reporting
obligations under other agreements pursuant to which Contractor receives funding.
6. Audit and Inspection. Wildfire will have the right to audit and inspect Contractor’s work to verify
compliance with this Agreement. Contractor agrees to provide Wildfire and its Fund Sources with access,
upon reasonable advance notice and during normal business hours, to all of Contractor's books and
records that relate to this Agreement. Contractor will maintain copies of all books and records that relate to
this Agreement for at least 3 years after the expiration of this Agreement.
7. Notices. All notices given in connection with this Agreement shall be in writing and sent by: (i)
hand delivery (ii) nationally recognized courier, (iii) facsimile, (iv) United States certified mail with return
receipt requested, postage paid, or (v) e-mail. All notices shall be deemed given and received when (a) if
given by facsimile, upon confirmed transmission during normal business hours (before 5:00 p.m. Arizona
time), if confirmed transmission is after normal business hours it will be deemed given and received the
next business day, (b) if hand delivered, when delivered (as confirmed by receipt executed by the recipient
or delivery confirmation executed by the courier), (c) if given by a nationally recognized courier, on the day
the notice is actually delivered (as confirmed by receipt executed by the recipient or delivery confirmation
by the courier), (d) if given by certified mail, return receipt requested, postage paid, when actually delivered
to the addresses specified herein as evidenced by return receipt or refusal or failure to accept delivery. All
notices will be given at the address or by use of the facsimile number or e-mail address specified for a
party on the signature page hereof. A party may change its mailing address, e‑mail address and/or
facsimile number for notice by giving notice to the other parties in accordance with this Section.
8. Limitation of Liability. Contractor acknowledges that all funds to be provided pursuant to this
Agreement will be provided by the Fund Sources, and Contractor agrees to look solely to funds actually
paid by the Fund Sources for Contractor invoices approved by the Fund Sources for all compensation and
reimbursement hereunder. Wildfire's obligations under this Agreement are subject to the Fund Sources
actually providing the funds (either to Wildfire or directly to Contractor) pursuant to the Program
Documents. Wildfire intends to allocate the funds from each Fund Source to multiple contractors. If one or
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more Fund Sources reduces their funding to Wildfire, then Wildfire reserves the right to reduce
Contractor’s funding under this Agreement and to allocate the reduced funding among Contractor and
other contractors as determined by Wildfire in its sole discretion.
9. Assignment; Subcontractors. Contractor may not assign Contractor's rights or obligations under
this Agreement without Wildfire's prior written consent, which consent Wildfire may withhold in its sole
discretion. Contractor may not use a subcontractor to perform any of Contractor's obligations under this
Agreement without Wildfire's prior written consent, which consent Wildfire will not unreasonably withhold.
Wildfire's consent to an assignment or subcontractor will not release Contractor from any obligations
hereunder.
10. Choice of Law and Forum. This Agreement has been entered into in Maricopa County, Arizona
and its application and interpretation shall be governed exclusively by its terms and by the laws of the
State of Arizona without regard to its choice of law rules. The exclusive and proper venue for any dispute
arising out of this Agreement will be the state and federal courts located in Maricopa County Arizona.
11. Integration; Modification; Waiver. This Agreement reflects the entire agreement of the parties
relating to the subject matter hereof. All recitals, Attachments and Exhibits to this Agreement are
incorporated herein by this reference. No provision of this Agreement shall be deemed waived, amended,
or modified by any party unless both parties sign a written amendment or the party against whom the
waiver is asserted signs a written waiver.
12. Counterparts; Email. This Agreement may be executed in counterparts and delivered via email.
13. Written Certification Under A.R.S. § 35-393.01. If the Contractor engages in for-profit activity and
has ten (10) or more employees and, if this Agreement has a value of $100,000 or more, then the
Contractor certifies it is not currently engaged in, and agrees for the duration of this Agreement not to
engage in, a boycott of goods and services from Israel. This certification does not apply to a boycott
prohibited by 50 U.S.C § 4842 or a regulation issued pursuant to 50 U.S.C § 4842.
14. Cancellation for Conflict of Interest. This Agreement is subject to cancellation within three (3)
years after its execution pursuant to A.R.S. § 38-511 if any person significantly involved in initiating,
negotiating, securing, drafting, or creating this Agreement of behalf of County is, at any time while this
Agreement or any extension of the Agreement is in effect, an employee or agent of any other party to the
Agreement with respect to the subject matter of the Agreement.
15. Exhibits.
Exhibit A Home Energy Assistance Fund Policy Manual FY 2025
Exhibit B Federal Poverty Income Guidelines effective July 1, 2024 – June 30, 2025
[Signature page follows]
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INDEPENDENT CONTRACTOR AGREEMENT
2024-25 Utility Assistance Programs
Signature Page
In witness whereof, the undersigned have executed this Agreement, effective as of the Effective Date.
CONTRACTOR
Maricopa County
Arizona Community Action Association (dba
Wildfire), an Arizona nonprofit corporation
Signature:
Name:
Title:
Date:
Signature:
Name: Kelly McGowan
Title: Executive Director
Date:
Signature:
Name:
Title:
Date:
Address:
340 E Palm Lane, Suite 315
Phoenix, AZ 85004
Email: kmcgowan@wildfireaz.org
Signature:
Name:
Title:
Date:
Address:
234 N Central Ave
Phoenix, AZ 85004
Email: brandon.bruce@maricopa.gov
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Jack Sellers
Chairman,
Maricopa County Board of Supervisors
Juanita Garza
Clerk of Board
Deputy County Attorney
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Exhibit A
Wildfire
Home Energy Assistance Fund
Policy Manual
FY 2025
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Table of Contents
Mission .............................................................................................................................. 4
Purpose and Principles ........................................................................................................ 4
Fund Sources Currently in Distribution .................................................................................. 4
Target Population ............................................................................................................... 4
Intake and Application ........................................................................................................ 4
Grants Management System (GMS) ...................................................................................... 5
Household Eligibility ............................................................................................................ 5
Frequency of Assistance ............................................................................................................... 5
Household Members ................................................................................................................... 6
Household Income ...................................................................................................................... 6
Income Eligibility ......................................................................................................................... 6
Condition of Crisis ....................................................................................................................... 6
Applicable crisis reasons .......................................................................................................... 6
Document Verification ........................................................................................................ 7
Identity Verification ..................................................................................................................... 7
Identity Verification Documents ............................................................................................... 7
Citizenship Verification (URRD and HEAF only) ............................................................................... 7
Income Verification ..................................................................................................................... 7
Countable Income Sources ....................................................................................................... 8
Excludable Income Sources ...................................................................................................... 8
Steps to Calculate and Verify Household Income ........................................................................ 8
Payment Guarantee Process ................................................................................................ 9
Information Included in Payment Guarantee Requests ............................................................... 9
Agency Reimbursement Process ........................................................................................... 9
Record Keeping .................................................................................................................. 9
Case Files .................................................................................................................................. 10
Documents Included in Case Files ........................................................................................... 10
Maintaining Records .................................................................................................................. 11
Payments Made to Ineligible Households ............................................................................ 11
Fraudulent Information and Conflict of Interest ................................................................... 11
Relatives of Applicants ............................................................................................................... 11
Agency Employees ..................................................................................................................... 11
Policy Changes and Clarifications ........................................................................................ 11
Distributing Funds and Monitoring Balances ....................................................................... 11
Monitoring/Audit Process .................................................................................................. 12
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Cooperation ..................................................................................................................... 12
Confidentiality .................................................................................................................. 12
Non-Discrimination Policy .................................................................................................. 13
Appeals Policy .................................................................................................................. 13
Appendix A: Countable and Excludable Income ................................................................... 14
Appendix B: Instructions for Verifying Citizenship and Non-Citizen Legal Permanent Resident
(LPR) Status ...................................................................................................................... 21
ATTACHMENT 1: PAYMENT GUARANTEE ........................................................................... 33
CONTACT INFORMATION ................................................................................................... 33
ATTACHMENT 2: PROGRAM SUMMARIES .......................................................................... 35
ATTACHMENT 3: SITE VISIT CHECKLIST .............................................................................. 55
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Mission
The Home Energy Assistance Fund (HEAF) at Wildfire develops and coordinates resources
through education, advocacy, financial assistance, and local partnerships throughout the state
of Arizona to help families meet their basic energy needs and move toward economic stability.
Purpose and Principles
This fund has been established to provide assistance to Arizona households in managing their
energy burdens. The purposes of the fund are to:
• Alleviate crisis situations by preventing disconnection and/or facilitating
reconnection of utility services
• Supplement currently existing energy assistance resources
• Identify new/additional sources of support
Fund Sources Currently in Distribution
• APS Crisis Bill Assistance
• Global Water LIRP
• SRP Bill Assistance
• Southwest Gas Energy Share –
Bill Assistance
• Southwest Gas Energy Share –
Repair/Replacement
• Southwest Gas LIEC
• TEP Bill Assistance
• Trico
• UNSE Electric
• UNS Warm Spirit Gas & Electric
• Utility Repair, Replacement and
Deposit
Target Population
Individuals and families throughout the state of Arizona, who find themselves in a position of
economic crisis, are encouraged to seek assistance from a community partner organization with
access to these funds.
Local organizations under contract with Wildfire to distribute these funds are encouraged to
provide outreach services to increase awareness of this program among the target population
who reside within the borders of their service area, including Native Americans living on tribal
reservations.
Intake and Application
Local partner agencies should utilize efficient and accessible intake processes to ensure services
are available to as many eligible households as feasibly possible in their service area. This may
include, but is not limited to, telephonic or web-based services. An appropriate
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intake/application form is recommended for use in the intake process to facilitate prescreening
and client data gathering.
Agencies should also provide low-income individuals who are not able to travel to the intake
site the means to submit an application without leaving their residence.
Grants Management System (GMS)
Appropriate data provided by clients in the application process must be entered into the Grants
Management System (see the GMS User Manual) at the time of application or on a monthly
basis by way of a pre-arranged, pre-approved data integration process.
Monthly transfers of applications from partner agencies utilizing the data integration process
must be received by the 10th day of the month, following any activity in the previous month.
All partner agencies must ensure that, by the 15th day of the month, applications in GMS from
the previous month reflect accurate and complete information.
Data received after the 15th may be reimbursed the following month.
Repair/Replace jobs may take longer than the 15th day of the following month; however,
expenditures should be entered into GMS as soon as they occur. If other fund sources are
utilized, expenditures using repair/replace should be entered into GMS prior to full completion.
Repair/replace jobs must be completed prior (and coordinated as such) to the end of the fiscal
year; otherwise, they will be billed to the new fiscal year contract.
Household Eligibility
Specific eligibility requirements for utility assistance vary by fund source. Comprehensive
outlines for these fund sources can be found in the Program Summaries. See Attachment 2 at
the end of this manual. The following eligibility topics apply to all fund sources.
Frequency of Assistance
Frequency of assistance within a 12-month period depends on the fund source. Clients may
return within a 12-month period, to seek additional assistance, but may or may not be eligible.
Refer to the Program Summaries for full eligibility details.
Depending on the fund source, current and past-due charges of the same fund source may be
combined but should not exceed the maximum fund source amount.
Agencies using GMS can determine whether a client has been served by a different agency in
the same year.
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Household Members
Each person living in the home is considered a household member. Income level and eligibility
will be determined based on the entire household, including roommates. Boarders, not related
by blood or law to the homeowner, are not considered household members for purposes of
eligibility determination.
For clarification, boarders pay rent to someone living in the same home, while roommates pay
rent to someone living outside the home. Income from each roommate is counted toward total
household income, while income from boarders is not.
Household Income
All income for household members 18 years of age and older must be counted toward total
household income, as well as the income of all household members 16 and 17 years of age who
do not attend school full time.
In cases of domestic violence, the income and resources of the abuser are not counted as long
as the client does not have access to the abuser’s income and resources.
Income Eligibility
Each fund source specifies an income threshold for households seeking assistance. These
thresholds are based on the Federal Poverty Level (FPL) guidelines. Updated information
outlining these guidelines will be attached to community partner contracts and should be
adhered to throughout the entire fiscal year.
Condition of Crisis
When required by the fund source, eligible clients must be experiencing a crisis in order to
qualify for services. There is no required timeframe wherein the crisis must have occurred.
Crisis reasons must be listed on the application. Additional documents verifying the crisis may
be required by specific fund sources. If documents verifying the crisis are unavailable, a client
affidavit form should be used to allow the client to attest to the validity of their crisis reason.
The form must be signed by the client. Refer to Program Summaries for information on crisis
requirement.
Applicable crisis reasons
1. Loss or reduction of income or public assistance benefits or a delay in receiving
public assistance benefits.
a. Examples include: loss of employment, theft of income, serious illness which
causes a loss of income, divorce, abandonment or death of a wage earner,
reduction of benefits or public assistance monies.
2. Unexpected and/or unplanned expenses that cause a lack of resources.
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a. Examples include: car repairs, medical bills, natural or man-made disasters,
death in the immediate family, court fines.
3. A condition that endangers the health and safety of the household.
a. Examples include: lead poisoning, condemned property, infestation,
domestic violence, asbestos, a medical condition that requires uninterrupted
utility service for life-saving equipment such as oxygen machines, heart
monitors, breathing machines, etc.
Document Verification
Identity Verification
The identity of the applicant must be verified before services can be provided. Any of the
documents listed below can be used for identity verification.
Identity Verification Documents
1. Driver’s license
2. Work or school ID
3. ID card from health benefits or social service program
4. Social Security card
5. Voter registration card
6. Wage stubs
7. Birth certificate
8. Family census card
9. Tribal ID
10. Other reasonable sources
In addition, the utility service address must be verified to match the applicant’s residential
address.
Citizenship Verification (URRD ONLY)
The Utility Repair Replacement Deposit (URRD) requires that the primary applicant be verified
as a U.S. Citizen or Qualified Immigrant. Information concerning this verification process and a
list of all federally accepted documents can be found in Appendix B of this manual.
Income Verification
Please refer to the Program Summaries, at the end of this manual, to determine income
verification requirements.
For those fund sources requiring income verification, in order to determine the eligibility of
applicants, all household income must be accounted for and verified. The most recent 30 days
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(up to and including the day of application) of countable income for each household member
must be verified. This includes earned and unearned amounts. In addition, gross income
amounts (not net income) must be counted, unless otherwise noted.
In cases where all attempts to obtain necessary income verification have failed, a client affidavit
form can be used to allow the client to attest to the validity of their income information. The
form must be signed by the client.
Some sources of income do not count against total household income. The following lists
include the most common sources of both countable and excludable income. For
comprehensive lists, please refer to Appendix A of this document.
Countable Income Sources
1. Earned income: employment, self-employment1
2. Benefit income: SSA, SSI, TANF-CA, VA, UI, GA
3. Pensions
4. Worker’s compensation
5. Child support
6. Work study
7. Other unearned income: rental income, and endowments or legal settlements
8. Tribal per capita
Excludable Income Sources
1. Food stamps and/or P-EBT
2. Medicare
3. WIC
4. AmeriCorps stipend
5. Earned income of a child under 16 years of age, or of a child that is 16 or 17 years of
age and is a full-time student
6. Income tax refund
7. Cash gifts of $50 or less per month per household member
8. Insurance payments
9. Foster care payments and adoption subsidies
10. Housing and Urban Development (HUD) benefits
11. Stimulus payments
12. Previous rental/utility assistance through other grants
Steps to Calculate and Verify Household Income
1. Identify the 30-day period prior to and including the application date.
2. Determine the number of sources of countable income received by all household
members during this 30-day period.
1 Net income will be counted for self-employment income (gross income less business related expenses).
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3. Determine the amounts of countable income received from each source for each
household member during this period.
4. Combine these amounts to reach the total, 30-day household income.
5. Compare this amount to the chosen fund source’s income threshold, based on the
number of household members.
6. Verify each amount from each income source using documents provided by the
client and preserve a copy of each document for the client’s file.
Payment Guarantee Process
Once a decision to approve a client’s application has been made and all documents have been
obtained and verified, a payment guarantee can be initiated on behalf of the client. Each fund
source has its own point of contact for receiving these guarantee requests. See Attachment 1:
Payment Guarantee Contact Information at the end of this manual. Payment guarantee
requests should include all of the information listed below and a hard copy placed in the file.
Information Included in Payment Guarantee Requests
1. Account number
2. Customer name on account
3. Customer address
4. Date of guarantee and guarantee amount
5. Fund source
6. Name of case worker requesting the guarantee
7. Name of organization requesting the guarantee
Agency Reimbursement Process
All guarantees and payments made by local partner agencies on behalf of clients are eligible for
reimbursement from Wildfire on a monthly basis. These guarantees and payments must be
accompanied by complete and accurate applications recorded properly in the Grants
Management System (GMS) in order to receive reimbursement from Wildfire. See the GMS
User Manual for clarification on this process.
Agencies will receive reimbursement for the amounts guaranteed plus any program delivery
amounts, as specified in contract. Funds received for guarantees made are dedicated funds only
for the purpose of paying for the guarantees and must be paid to the respective utility company
as soon as possible. Funds received for program delivery have no restrictions and may be used
at the discretion of the agency.
Record Keeping
The applicant has the primary responsibility to provide all required documents. In situations
where it is difficult for the applicant to obtain documents needed to complete the eligibility
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determination, the local partner agency should offer assistance to the client in obtaining the
information.
In cases where all attempts to obtain necessary documents have failed, a client affidavit form
can be used to allow the client to attest to the validity of any eligibility information provided.
The form must be signed by the client. The client affidavit cannot be used to verify U.S.
Citizenship or Legal Permanent Resident status for applicable fund sources. Please see
Appendix XXXX for citizenship affidavit.
Case Files
Supporting documentation for each client application must be kept in individual case files. Each
file must contain all of the necessary documents to support the eligibility determination
decision reached by the agency. Case files for every fund source must contain the documents
listed below. Electronic records are sufficient.
Documents Included in Case Files2
1. Intake/Application with client info and name of Case Manager
2. Verification document for ID of client
3. Citizenship verification of primary applicant (for HEAF and URRD only)
4. Utility bill (or receipts for purchases of fuel), matching applicant’s service address
5. Income verification
6. Documents verifying crisis (if required by fund source)
7. Client affidavit form (if utilized)
8. Statement of truth and release of information form, signed by the client^
9. Copy of completed payment guarantee request
10. Proof of ownership of appliance (repair/replace)
11. Verification of job completion with client signature (repair/replace)
Additional documents may be required by certain fund sources when indicated on the fund
source program summary.
^A hard copy of the Approval/Denial Letter signed by the client, which includes the statement
of truth and release of information, should also be placed in the file. For agencies that batch
monthly, the signed statement of truth and release of information can be on a separate
document. A hard copy of this document needs to be placed in the file.
Client Affidavit may be used in place of the following:
• Documents verifying crisis
• Income verification
2 Agencies may be granted reasonable exemptions from including certain documents in case files. Contact Wildfire staff for
exemption requests.
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Maintaining Records
Local partner agencies are required to maintain supporting financial records, documentation,
and statistical records for three years.
Payments Made to Ineligible Households
If assistance is provided to an ineligible household due to a Case Manager’s error, an over-
expended fund source, or if the client was found to be ineligible after the payment was made,
the award to the household must be honored and the partner agency will be responsible for
repaying the award amount to Wildfire and paying the guarantee using funds other than those
provided to the agency by Wildfire. The partner agency has the right to appeal any repayment
determination directly to Wildfire.
Fraudulent Information and Conflict of Interest
If a client is found to be fraudulent in his/her application and the payment has not been sent to
the utility, the payment must be stopped and the client appropriately informed.
Relatives of Applicants
Case Managers are not permitted to complete applications for their own relatives to the first-
cousin level including step and in-law relatives. Specifically, parents, siblings, spouses, aunts,
and uncles are to be interviewed by another Case Manager or supervisor.
Agency Employees
Agency employees should not be denied the right to apply for and receive services through this
program. These individuals or members of their households may apply for assistance; however,
a supervisor must conduct the application intake process.
Policy Changes and Clarifications
Revisions to any policies and procedures will be reviewed and approved by the Wildfire Home
Energy Assistance Fund Advisory Board and the Wildfire Board of Directors.
All revisions will be sent to local partner agencies as they occur. Partner agencies have the
responsibility to update their own information as revisions are received. Issues regarding policy
and/or procedures must be submitted in writing.
Distributing Funds and Monitoring Balances
Local partner agencies are responsible for monitoring the ongoing balances of each fund source
under contract with Wildfire, throughout the course of the contract year. All funds must be
distributed to eligible clients by the end of the contract year and over-expenditures must not be
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allowed. Any over-expenditure incurred by the agency must be repaid to Wildfire using funds
other than those provided to the agency by Wildfire.
There is an expectation that agencies fully expend their fund sources by the end of their annual
contract. Agencies are also expected to account for projected spending and consider potential
redistribution to other agencies if they are unable to meet targeted expenditures.
Repair/replacement jobs should be submitted at the time of completion, even if part of the
larger weatherization job may not be finished. Repair/replace jobs must be completed prior
(and coordinated as such) to the end of the fiscal year, otherwise they will be billed to the new
fiscal year contract.
Monitoring/Audit Process
Partner agencies are responsible for ensuring that all policies and procedures are being
followed. Wildfire staff will conduct an audit of application and case files during annual
monitoring visits. The following four, general elements are reviewed in every audit.
General Elements of an Audit
1. Accuracy of information
2. Client eligibility, based on the fund source utilized
3. Completeness of the client file (all required documents included)
4. Demonstration of payment guarantee to utility company or completion of job
related to URRD
Wildfire recommends agencies complete regular internal audits on utility assistance files in
preparation for future visits.
Cooperation
Applicants must cooperate in all aspects of the application process. Applicants must provide
requested information or verification and complete and sign an application. If the applicant
refuses, the application will be denied. The partnering agency should document the lack of
cooperation by the applicant for proper notation in refusal of assistance.
Confidentiality
All information, regarding an applicant or recipient, is confidential and may be disclosed only
for purposes of determining eligibility, providing services, or investigating suspected fraud in
connection with the program. Applicants authorize access to their records by signing the
release of information form. Anyone not authorized on the application must have the
applicant's written approval to access information.
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Information that can be divulged must pertain to the eligibility of the applicant, and excludes
items that do not address eligibility, i.e. personal details. Inappropriate disclosure of
information can result in severe disciplinary action or could result in the suspension of the
partnering agreement.
Access to information by inappropriate, unauthorized individuals or parties shall be considered
a violation of the individual's right to confidentiality. The Contractor shall take reasonable steps
to safeguard, secure and maintain the confidentiality of any and all individual information in its
possession, and to protect such information from unauthorized access, use or disclosure,
utilizing the same degree of care it uses to protect its own confidential information and, in no
event, less than a commercially reasonable degree of care. All records shall be open to any and
all federal, state, and contractor auditors and/or examiners in the course of their regular audits.
In the event that an agency receives a request to produce or disclose documents that contain
any confidential information pursuant to a valid public records request, or other applicable law,
order, or court ruling, the agency must promptly notify Wildfire before honoring the request.
General information, policy statements, or statistical materials that cannot be directly identified
with any individual or family are not considered confidential. They may be given to, or provided
by: agencies, helping organizations, or contracted parties (unless restricted by Arizona statutes,
federal regulations, or court orders).
Non-Discrimination Policy
In compliance with Title VI of the Civil Rights Act of 1964 and Executive Order 12250, no
individual in Arizona shall be excluded from participation in, denied benefits from, or subjected
to discrimination under any program or activity receiving federal funds because of: race, color,
national origin, disability, religion, or sex, or sexual orientation.
In compliance with the Age Discrimination Act of 1975, no individual shall be denied services or
participation or be subjected to discrimination in any of its programs or activities on the basis of
age.
Appeals Policy
The client/agency has the right to appeal a denial of assistance or an awarded grant amount.
Appeals by the client must follow the policies of the intake partner agency and will be
addressed by Wildfire administrative staff.
Complaints regarding the service of the administering agency, discrimination or other issues
directly related to the administering agency and staff must be addressed to the office where
the application was made.
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Appendix A: Countable and Excludable Income
Countable Income
EARNED and/or UNEARNED income will be considered in determining eligibility for services. The
gross amount of income prior to deductions will be counted unless otherwise specified.
Earned Income
Earned income is defined as either cash or in-kind income received as compensation for wages,
salaries, commissions or profit through employment or self-employment.
Earned income includes but is not limited to:
1. ARIZONA TRAINING PROGRAM (ATP): Salaries to handicapped persons working in a
sheltered workshop situation are counted. Verbal or written verification may be obtained
from ATP.
2. BABY-SITTING OR CHILDCARE INCOME: Earnings from baby-sitting are counted as self-
employment income. Verbal or written verification may be obtained from DES or the person
paying for the care.
3. CAN OR BOTTLE SALES OR OTHER USABLE DISREGARDS: Income from these sales is counted
as self-employment income. Client should have receipts for such sales. If receipts are not
available, a signed and dated client statement would be acceptable.
4. CONTRACT INCOME: Income received by individuals who are employed under a contract
that states a specific length of time and a specific income amount to be paid during that
time.
5. HOUSEKEEPER OR HOME HEALTH AIDES: Income earned as a housekeeper or home health
aide is countable. Verbal or written verification may be obtained from the employer.
Income is only counted once, if living in the household and paid by the applicant.
6. IN-KIND EARNED INCOME: Work performed by a client in exchange for room, board, or
other needs is earned in-kind income. The employer will establish the monetary value of the
service. A collateral contact or a signed and dated statement from the employer, or client
can verify in-kind income. The employer may be, but is not limited to:
a. A landlord who is providing rent or portions of the rent or utilities in exchange for
work.
b. A storeowner who gives goods, such as groceries, clothes or furniture in exchange
for work.
c. An individual who receives a car, tools, trailer, building material, gasoline, etc. in
exchange for work.
7. JURY PAY: Counted as earned income. Check stubs should be available to verify income.
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8. MILITARY INCOME: Wages received while in the military are countable. This includes: base
pay (BP), Proficiency pay (PRO), rations (separate/leave), basic allowance for housing (BAQ),
basic allowances for subsistence (BAS) and variable housing allowance (VHA) when
considered an entitlement. Use the leave and earnings statement, when available, to verify
the amount of earned income issued.
9. RENTAL INCOME: Any monies received from rental of property, including boarders, less
expenses, are counted as earned income if work is involved.
a. Work includes, but is not limited to, managing rental property requiring
maintenance, collection of rent or accounting functions. There is no time
requirement for number of hours worked.
b. If a person's income from rental of property does not require work, rent is
considered unearned income.
10. SELF-EMPLOYMENT INCOME AND EXPENSES: Self-employment includes but is not limited
to, businesses such as grocers, craftsmen, taking in boarders, ranching, farming, swap meet
sales, odd jobs, baby-sitting, can and bottle collection, janitorial, guide for hunting or fishing
or any wholesale or retail sales.
Clients are not considered self-employed if they work for a business or another person on a
commission basis, unless the client reports and pays his/her own withholding taxes for
state, federal and FICA.
Acceptable verification for self-employment is:
a. IRS Form 1099
b. Ledger statement
c. Client statement
When calculating self-employment income, the client may deduct any business expenses.
Gross incomes minus business expenses equals countable income.
11. VOCATIONAL REHABILITATION (VR): Wages from VR sponsored on-the-job training (OJT) are
countable.
12. WAGES: Gross earnings from employment, prior to any deductions, garnishments,
allowances or adjustments. Special benefits or deductions connected with employment
earnings are counted as follows:
a. Advances, bonuses and commissions must be counted as earned income in the
month received.
b. When tips are shown on the paystub and the household claims a lesser amount but
has no record of actual tips received, count the amount on the paystub.
c. When tips are not shown on the paystub, obtain the individuals’ written tip record.
When not available, obtain a written statement from the household or contact the
employer.
13. WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA): Earnings from employment
through WIOA will be counted for persons age 18 and over.
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14. WORK STUDY: Earnings received from the following: Work-study programs, when the funds
do not come under Title IV of the Higher Education Act; Veterans Administration work-study
program.
Unearned Income (countable)
Unearned income is defined as income, which was not received as a result of the performance of a
service, or earned from sources other than employment, self-employment or in-kind income.
Countable unearned income includes but is not limited to:
1. ALIMONY OR SPOUSAL MAINTENANCE: A court-ordered support amount, which a legally
divorced or separated person pays to the spouse, must be counted. Verbal or written
verification may be obtained from the office of the Clerk of the Court or Division of Child
Support Services.
2. ASSISTANCE PAYMENTS: such as General Assistance (GA) or Cash Assistance (CA) from this
state, as well as, other states must be counted.
3. BUREAU OF INDIAN AFFAIRS (BIA):
a. BIA-General Assistance payments are public assistance and treated as any other
assistance payments.
b. Clothing allowances available to the individual, whether in cash or a voucher made
out to the individual must be counted.
c. Tribal Work Experience Program (TWEP) or Tribal Assistance Project Program
(TAPP). Exclude any portion of the amount, which is an incentive payment.
4. CHILD SUPPORT: Any payment received directly by the household from an absent parent or
paid through the Division of Child Support Services or Clerk of the Court. Only the amount
paid to the client is counted (CP) = child support payment. All child support income is
considered unearned income.
5. COMMISSIONS: Commissions received from a terminated source of employment are
counted as unearned income.
6. CONTRIBUTIONS AND COMPLIMENTARY ASSISTANCE: Cash contributions must be counted
as unearned income, if not considered as gifts or child support.
7. INDUSTRIAL COMPENSATION: The amount of the compensation, after attorney's fees are
deducted, is unearned income. The Industrial Claim award letter will verify amount being
paid but will not verify the attorney's fees.
8. INDIAN GAMBLING INDUSTRY: Per capita disbursements are considered income in the
month received. Any amount remaining in a following month will be counted as a resource.
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9. INSURANCE: Insurance payments made directly to the insured must be considered income
IF the money is not used to replace or repair insured items, such as car, roof repair, or
medical bills. Insurance benefits, which are used for or are intended to meet basic daily
needs, are counted as unearned income.
10. INTEREST, DIVIDENDS, AND ROYALTIES: Any interest, dividend, or royalty payments,
exceeding $50 in the 30 days prior to and including date of application made directly to the
individual, are counted as unearned income. Funds left on deposit or converted into
additional securities are a resource.
11. LEGAL SETTLEMENTS: Legal settlements, less attorney fees and medical bills paid by the
attorney out of the settlement, are unearned income in the month received.
12. MORTGAGES AND SALES CONTRACTS: Payments received from mortgages or sales contracts
are counted. Includes payment received from a reverse mortgage.
13. LUMP SUM PAYMENT: Any form of income received in a lump sum payment, including but
not limited to:
a. Inheritance
b. Winnings from lotteries, bingo, or any other form of gambling
c. Insurance settlements including amount withheld as a lawyer’s fee
d. Property Tax Credit
e. Rebates/Credits
f. Refund Deposit
g. Severance Pay
14. RENTAL INCOME: If the property owner does not perform any services in order to receive
the income, it is unearned income.
15. RETIREMENT INCOME: The payments from retirement funds, pensions, and annuities must
be considered unearned income.
16. SOCIAL SECURITY ADMINISTRATION BENEFITS: SSA benefits (sometimes referred to as RSDI-
Retirement, Survivors, and Disability Insurance) are granted to eligible wage earners and/or
their dependents or survivors and are counted as unearned income. Do not include the
Medicare deduction in the total amount.
17. SUPPLEMENTAL SECURITY INCOME (SSI): Monthly cash payments made under the authority
of Title XVI of the Social Security Act, as amended, to the aged, blind, and disabled (A
Federally financed public assistance program). The recipient need not have contributed to
the Social Security Fund to be eligible for SSI benefits.
18. STRIKE PAY: from unions to striking employees is not wages and must be considered
unearned income. If there is no check stub, verification can be obtained by calling the union.
19. UNEMPLOYMENT INSURANCE (UI): Considered unearned income in the month received.
The amount of income can be verified by a check stub or contacting the local UI office.
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20. VETERANS ADMINISTRATION BENEFITS (VA): Retirement, Survivors, Disability, and
Educational Benefits are paid to veterans and their dependents or survivors. Only the
amount of the benefit, which is actually received by the person whose income must be
included, will be counted.
Excludable Income
Only the income discussed in this section will be excludable:
1. Insurance payments designated to repay a specific bill, debt, or estimate, which cannot be
used for other needs, is not countable
2. WIC – Payments or benefits to persons participating in the WIC program (Special
Supplemental Food Program for Women, Infants, and Children) must be disregarded
3. Retirement, pension, and annuity interest/dividends are not countable as long as the money
cannot be withdrawn without penalty
4. Bureau of Indian Affairs (BIA) work-study program. This includes monies provided for
educational and living expenses
5. Work study programs funded under Title IV of the Higher Education Act
6. Any portion of an education grant or scholarship received by a household member
7. Earned income of a child 16 and 17 years of age who is a full-time student
8. Earned income of a child under 16 years of age
9. Cash gifts of $50.00 or less per month per household member
10. Non-cash benefits provided on behalf of a household member but not paid directly in the
name of the household member, including but not limited to vouchers for food, clothing, or
housing
11. Loans that need to be repaid
12. Money that a household member receives and uses for the care and maintenance of a
person who is not a household member
13. Payments/vouchers received by the household from the State for the health/well-being of a
foster child residing in the household
14. Stipends from senior companion programs – VISTA, Title II, Title V
15. Earned Income Tax Credit
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16. Income Tax Refund
17. Reimbursements, e.g.; mileage, gas, lodging and meals
18. Agent Orange Payments
19. AmeriCorps Network Program payments for living allowances, earnings, and in-kind aid. The
AmeriCorps Network Program includes but is not limited to:
a. Arizona Conservation Corp
b. Arizona Council of Centers for Children and Adolescents (ACCCA)
c. Border Volunteer Corps (BVC), Mesa AmeriCorps Community Services
d. Partnership Rural Health Office, University of Arizona, Youth in Action, Learn and
Serve (NAU) Child Care Food Program payments
20. Disaster or emergency assistance provided by the Federal Disaster Relief Act or comparable
assistance provided by States, local governments and disaster assistance organizations
21. Housing and Urban Development (HUD) – Some individuals residing in HUD housing are
granted benefits either in the form of credits against their rent or as cash allowances. The
cash allowance must be used for the purpose intended, (rental or utility obligation)
22. Education and Employment: (a) Any wages, allowances, or reimbursement for
transportation and attendant care cost, unless accepted on a case-by-case basis, when
received by an eligible handicapped individual employed in a project under Title VI of the
Rehabilitation Act of 1973 as added by Title II of Public Law 95-602.
23. Payments to members of specific Indian Tribes and Groups:
a. Settlement fund payments and the availability of such funds to members of the Hopi
and Navajo Tribes under section 22 of Public Law 93-531 (88 Stat. 1722) as amended
by Public Law 96-305 (94 Stat. 929) (Note: This exclusion applies to the income of
sponsors of aliens only if the alien lives in the sponsor's household.)
b. Any distributions of judgment funds to members of the San Carlos Apache Indian
Tribe of Arizona under section 7 of Public Law 93-134 (87 Stat. 468) and Public Law
97-95 (95 Stat. 1206) (Note: This exclusion applies to the income of sponsors of
aliens only if the alien lives in the sponsor's household.)
24. Adoption Subsidies/Reimbursements
Adoption Subsidy payments are federally, state, or locally funded assistance
payments provided to children with special needs. These payments are intended to
help a child whose special needs otherwise might hinder their adoption. Adoption
Subsidy payments vary depending on the special needs of the child. Adoption
subsidy payments are NOT COUNTABLE as income.
25. Other:
a. Compensation provided to volunteers by the Corporation for National and
Community Service (CNCS), unless determined by the CNCS to constitute the
minimum wage in effect under the Fair Labor Standards Act of 1938 (29 U.S.C. 201
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et seq.), or applicable State law, pursuant to 42 U.S.C. 5044(f) (1) (Note: This
exclusion does not apply to the income of sponsors of aliens.)
b. Any assistance to an individual (other than wages or salaries) under the Older
Americans Act of 1965 as amended by Section 102 (h) (1) of Pub. L. 95-478 (92 Stat.
1515, 42 U.S.C. 3020a)
c. Amounts paid as restitution to certain individuals of Japanese ancestry and Aleuts
for losses suffered as a result of evacuation, relocation, and internment during
World War II, under the Civil Liberties Act of 1988 and the Aleutian and Pribilof
Islands Restitution Act, sections 105(f) and 206(d) of Public Law 100-383 (50 U.S.C.
App. 1989 b and c)
d. Payments made under section 6 of the Radiation Exposure Compensation Act, Public
Law 101-426 (104 Stat. 925, 42 U.S.C. 2210)
e. Payments made to individuals because of their status as victims of Nazi persecution
excluded pursuant to section 1(a) of the Victims of Nazi Persecution Act of 1994,
Public Law 103-286 (108 Stat. 1450)
f. Any matching funds from a demonstration project authorized by the Community
Opportunities, Accountability, and Training and Educational Services Act of 1998
(Pub. L. 105-285) and any interest earned on these matching funds in an Individual
Development Account, pursuant to section 415 of Pub. L. 105-285 (112 Stat. 2771)
g. Any earnings, Temporary Assistance for Needy Families matching funds, and interest
in an Individual Development Account, pursuant to section 103 of the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (Pub. L. 104-193, 42
U.S.C. 604(h)(4))
h. Payments made to individuals who were captured and interned by the Democratic
Republic of Vietnam as a result of participation in certain military operations,
pursuant to section 606 of the Departments of Labor, Health and Human Services
and Education and Related Agencies Appropriations Act of 1996 (Pub. L. 105-78)
i.
Payments made to certain Vietnam veterans' children with spinal bifida, pursuant to
section 421 of the Departments of Veterans Affairs and Housing and Urban
Development, and Independent Agencies Appropriations Act of 1997 (Pub. L. 104-
204, 38 U.S.C. 1805(a))
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Appendix B: Instructions for Verifying Citizenship and
Qualified Immigrant Status
Definition of U.S. Citizenship
U.S. citizenship is established at birth when an applicant is born in the U.S., its territories, or
possessions. U.S. territories or possessions include any of the following:
•
American Samoa
•
Guam - on or after January 17, 1917
•
Northern Mariana Islands - on or after November 4, 1986
•
Panama Canal Zone – on or after February 26, 1904
•
Puerto Rico - on or after July 1, 2010 (Senate Bill 1182, Law #191 of 2009)
•
Swain Islands
•
U.S. Virgin Islands - on or after January 17, 1917
Verification of U.S. Citizenship
TO BE POTENTIALLY ELIGIBLE APPLICANTS WHO DECLARE U.S. CITIZENSHIP OR LEGAL RESIDENT
STATUS MUST PROVIDE DOCUMENTATION FOR VERIFYING, WITH THE FOLLOWING EXCEPTIONS:
The following participants are exempt if they are receiving the following services:
•
Currently receiving Social Security Disability (SSD).
•
Currently receiving Supplemental Security Income (SSI). This includes participants who move
here from another state and are in the process of transferring their SSI benefits to Arizona.
•
Currently receiving Medicare.
•
Eligible in the Deemed Newborn MA category.
•
Children in Foster Care assisted under title IV-8 of the Social Security Act. Children who are
recipients of Foster Care maintenance or adoption assistance payments under title IV-e.
•
Children receiving adoption subsidies.
Note: The participants receiving the service must provide an award letter or documentation as
proof of receiving the service. Once the participant is no longer receiving the benefits that meet the
exemption criteria, they must then provide the proper and approved documentation as described in
the section below.
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Approved Documentation
Citizenship may be verified using ANY of the documents indicated under sections A, B, C or D below:
A. Primary – Verification Documents
1.
A birth certificate showing birth in the U.S., its territories or possessions.
2.
Certificate of Birth issued by the Department of State (FS-545 or DPS-1350).
3.
U.S. Passport current or expired, except limited passports which are issued for periods of
less than 5 years.
4.
U.S. Passport Card issued by the United States Citizenship and Immigration Services
(USCIS).
5.
Certificate of Naturalization (N-550 or N-570).
6.
Certificate of U.S. Citizenship (N-560 or N-561).
7.
Report of Birth Abroad of a U.S. Citizen (FS-240) issued by the U.S. State Department.
8.
U.S. Consular officer's statement.
9.
A United States Citizen Identification Card (I-197).
10.
Northern Mariana Identification Card (I-873).
11.
A tribal enrollment card or Certificate of Indian Blood issued by a federally recognized
Indian Tribe that shows that the person is enrolled or affiliated with that tribe.
12.
American Indian Card (I-872) issued by USCIS with the classification code KIC. The benefit
granting Service Provider shall require the applicant to present a membership card or
other tribal document demonstrating membership in an Indian tribe. If the applicant has
no document evidencing tribal membership, the benefit granting Service Provider should
contact the Indian tribe for verification of membership.
B. Secondary – Verification Documents
1.
An identification card for use of Resident Citizen (I-179).
2.
U.S. Census record that shows the applicant's name, a U.S. place of birth and the date of
birth or the applicant's age when the record was made. It must also indicate a place of
birth in the U.S., its Territories or Possessions.
3.
Religious record created within three months after birth, showing the participant's date of
birth, OR the participant's age when the record was made. It must indicate a place of birth
in the U.S., its Territories or Possessions.
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4.
Proof of employment as a U.S. Government Civil Servant before June 1, 1976.
5.
Early school records, showing the date of admission, the child's date and place of birth
and the names and places of birth of the parents.
6.
Adoption finalization papers showing the child's name and place of birth in the U.S., its
territories or possessions. (When adoption is not finalized and the State will not release a
birth certificate prior to final adoption, a statement from a state approved adoption
Service Provider containing the child's name and place of birth may be used. The source of
information must be an original birth certificate and must be indicated in the statement).
C. Primary or Secondary Documents Are Not Available
When none of the primary or secondary documents are available, accept any other document that
establishes a U.S. place of birth or in some way indicates U.S. Citizenship. These include the
following:
1.
Certificates of Live Birth signed by a hospital official and parent
2.
Medical records created at least five years before applying for services that list a U.S.
place of birth (For children under age 16 the documents must be created near the time of
birth OR five years prior to the application date. These include: hospital wrist bands, crib
cards, or yellow copies of hospital birth certificates indicating birth in the U.S., its
territories or possessions (See U.S. Citizenship on page 1).)
3.
American Indian Census Records
4.
Verification from the U.S. Citizenship and Immigration Services (USCIS). The
documentation CANNOT be expired.
5.
Verification from the Social Security Administration, e.g. award letter
6.
Verification sent directly to the agency from a local, state or federal bureau of vital
records office
7.
Legal records showing the applicant’s name and place of birth in the U.S., its Territories or
Possessions
8.
Department of Homeland Security (DHS), Verification Information System (VIS) response
that validates U.S. Citizenship
9.
Online data match screen print with the Arizona Department of Vital Records through the
AHCCCS Citizenship Verification System
•
AHCCCS Award Letter is acceptable verification
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10.
Military papers - When verifying military service criteria, the following apply:
a.
An honorably discharged veteran of the Armed Forces of the U.S. must present an
original or notarized copy of the veteran’s discharge papers
b.
Verify active duty status with an original or notarized copy of the applicant’s
current orders or a military ID card (DD form 2(active))
c.
A spouse or unwed dependent child of a veteran or active duty non-citizen must
provide a document to verify relationship along with military verification
requirements
d.
A stepchild living with the stepparent must provide documents to verify
relationship along with military verification requirements
11.
Marriage certificate showing marriage to a U.S. male citizen before September 22, 1922
12.
Life, health or other insurance record, created at least five years before the application
date (Record must indicate a place of birth in the United States)
13.
State census records that show the participant’s name, a U.S. place of birth, and the date
of birth or age of the participant
14.
Tribal census records for the Navajo or Seneca tribes (The records must be created at least
five years before the application and list a U.S. place of birth.)
15.
An official notification of birth registration from a U.S. State’s Department of Vital
Statistics
16.
An amended U.S. public birth record that is amended more than five years from the
applicant’s birth
17.
A statement signed by the physician or midwife who was in attendance at the time of
birth
18.
The roll of Alaska Natives from the Bureau of Indian Affairs
19.
A current decision letter from the ADES/Family Assistance Administration that
demonstrates eligibility for the Food Stamp or Cash Assistance Programs (The award letter
must list the applicant as an eligible member of the household).
20.
A DES SNAP/TANF case management system record match, indicating that the individual is
currently receiving SNAP or TANF benefits.
D. Primary or Secondary Documents Not Obtainable
When the applicant cannot obtain the Primary or Secondary forms of verification, they may provide
an Affidavit Attesting Citizenship (this is separate from the client affidavit form provided by
Wildfire). An Affidavit Attesting Citizenship must meet all of the following requirements:
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1.
Be completed by a U.S. Citizen who is knowledgeable about the participant’s
circumstances
2.
Be signed by a U.S. Citizen that is not a member of the household
3.
Be approved by the Case Manager Supervisor
4.
Document the reason for using the affidavit form
Only original or un-tampered copies of required documents are acceptable for verifying citizenship.
Verification of Qualified Immigrants
Applicants, who state they are Resident Immigrants, must meet at least one of the categories set
forth below:
A. Resident Immigrants
A Resident Immigrant is admitted into the U.S. for permanent residence under the Immigration and
Nationality Act (INA). This Resident Immigrant is potentially eligible for services when they meet any
of the following:
1.
They have been continuously lawfully residing in the U.S.
2.
They have a military connection
3.
They are American Indians born in Canada who possess at least 50 per quantum of
American Indian Blood. These Non-Citizen Legal Residents are recognized as immigrants
These applicants normally have one of the following USCIS documents.
(NOT ACCEPTABLE IF DOCUMENTS ARE EXPIRED):
1.
I-551- Resident Alien Card (Eligible for Benefits)
2.
I-151- Alien Registration Receipt Card (Eligible for Benefits)
3.
I-194- or unexpired passport with the words: Processed for I-551
Temporary Evidence of Lawful Permanent Residence – Valid Until (Date)
With the following Stamp/Annotations of Law
1.
Adjustment Admission Stamp - Eligible when any of the following sections of law are
indicated: 203(a)(7); 207;208;212(d)(5); 243(h)(with a PRUCOL determination)
2.
Non-Specific Admission Stamp -Eligible when the form is noted with an I- 551 eligible
status code
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3.
Parole Admission Stamp - Eligible when the period of parole is for at least one year as
verified on the stamp
4.
Replacement Admission Stamp - Eligible when the stamp displays an I-551 eligible Status
Code
5.
Temporary I-551 Admission Stamp - Eligible when the key phrase reads one of the
following:
a.
"Admission for Permanent Residence at: “D" or "Processed for I-551 Temporary
evidence of admission for Permanent Residence" and displays one of the following
Status Codes: AM1; -2; -3; -6; -7; -8,
b.
Asylee
i.
An Asylee, Non-Citizen Legal Resident is granted asylum through an exercise
of discretion by the Attorney General, pursuant to Section 208 of INA. This
Non-Citizen is potentially eligible for benefits for a period of seven years
from the date their status is granted.
ii.
These applicants normally have one of the following USCIS documents. (NOT
ACCEPTABLE IF DOCUMENTS ARE EXPIRED):
1. I-94 with one of the following:
a. A stamp showing grant of asylum under Section 208 of the
INA to include:
i. AS1 - Eligible for benefits
ii. AS2 - Eligible for benefits
iii. AS3V92 - Eligible for benefits
Note: The eligibility period begins from the month the Asylee status is granted,
NOT the month of U.S. entry.
B. Refugee or Amerasian
A Refugee or Amerasian is admitted into the U.S. under Section 207 of INA. This Non-Citizen is
potentially eligible for benefits for a period of seven years from the date that their status is granted.
These applicants normally have one of the following USCIS documents:
(NOT ACCEPTABLE IF DOCUMENTS ARE EXPIRED):
1.
I-94- endorsed to show entry as a refugee under Section 207 of the INA or entry as an
Amerasian OR noted with one of the following Status Codes: NP2 – 7; P2 -6, -7, -71; RE-8;
Z2; (Eligible for Benefits).
C. Victim of Human Trafficking
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A victim of human trafficking is admitted onto the U.S. under the Trafficking Victims Protection Act
(TVPA) of 2000. This Non-Citizen Legal Resident is potentially eligible for services for a period of
seven years from the date that their status is granted.
These applicants normally have one of the following USCIS documents:
(NOT ACCEPTABLE IF DOCUMENTS ARE EXPIRED)
1.
I-94- with a T Visa or Derivative T Visa (T, T-2, T-3, T-4, or T-5)
D. Non-Citizen Legal Resident Paroled Into The U.S.
A Non-Citizen paroled into the U.S. is lawfully present in the U.S. as a result of a grant of parole by
the Attorney General, pursuant to Section 212(d) (5) of the INA. This Non-Citizen is potentially
eligible for services when the period of the parole is for at least one year.
These applicants normally have one of the following USCIS documents:
(NOT ACCEPTABLE IF DOCUMENTS ARE EXPIRED):
1.
I-94 - with PAROLE PURSUANT TO SECTION 212(d) (5) on the front.
The form must not be expired, and the expiration date must be at least one year after the issue
date. Both dates are documented on the form (Eligible for Benefits).
E. Non-Citizen Legal Resident Whose Deportation Is Withheld
A Non-Citizen Legal Resident whose deportation is withheld is a Non-Citizen Legal Resident for
whom the Attorney General has withheld deportation from the U.S. pursuant to Section 243(h) or
241 (b)(3) of the INA. A Non-Citizen Legal Resident whose deportation is withheld is potentially
eligible for services for a period of seven years from the date of the judge's orders.
These applicants normally have one of the following USCIS documents:
(NOT ACCEPTABLE IF DOCUMENTS ARE EXPIRED).
1.
I-94 -with an order from an immigration Judge showing one of the following:
a. Deportation withheld under 243(h) of the INA (Eligible for Benefits)
b. Removal withheld under 241(b)(3) of the INA (Eligible for Benefits)
F. Cuban or Haitian Entrant
Cuban or Haitian entrants are admitted to the U.S. by USCIS as a Cuban or Haitian entrant pursuant
to Section 501 (e) of the Refugee Education Assistance Act of 1980 (PL 104-93). Cuban or Haitian
entrants are potentially eligible for benefits for a period of seven years from the date that their
status is granted.
These applicants normally have the following USCIS document:
(NOT ACCEPTABLE IF DOCUMENTS ARE EXPIRED)
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1.
I-94 with the words: CUBAN/HAITIAN ENTRANT UNDER 212(D) OF THE INA (Eligible for
Benefits)
G. Conditional Entrant
A conditional entrant was granted conditional entry into the U.S. before April 1, 1980, pursuant to
Section 203 (a) (7) of the INA. Conditional entrants are potentially eligible for benefits regardless of
any later change in their status.
These applicants normally have one of the following USCIS documents.
(NOT ACCEPTABLE IF DOCUMENTS ARE EXPIRED):
1.
I-94 – with the words: ADMITTED AS A REFUGEE – CONDITIONAL ENTRY under Section
203(a) (7) of the INA. (Eligible for Benefits)
H. Abused or Battered Resident Immigrants
Documented non-citizen asylum seekers may become qualified Resident Immigrants when they
have suffered abuse from a parent or a spouse.
The Service Provider staff must inform the abused or battered applicant of the following:
1.
Applicant must contact the USCIS to obtain a Petition for Abused Aliens
2.
The abuse must have occurred in the U.S. and the abusive person must be a U.S. Citizen or
Lawful Permanent Resident
3.
They must currently reside in the U.S.
4.
They must provide any and all documentation verifying continuous residency in the U.S.
for the prior five years
Note: All periods of time that are not accounted for must be addressed by an applicant statement.
In order for the Resident Immigrant to be eligible under this category, they must meet ALL of the
following:
1.
Possess appropriate USCIS status
2.
Be battered or subject to extreme cruelty
3.
Have a substantial connection between battery and the need for benefits
4.
No longer residing with the batterer
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I. Indefinite Detainee
Indefinite detention status pertains to Non-Citizens who have served their time for a criminal
conviction and have been given formal orders to leave the U.S. Subsequently, Indefinite Detainee
status is met when the Non-Citizen is allowed to indefinitely remain the U.S. because neither their
home country, nor any other country will accept them.
J. Military Connection
Non-Citizens who meet both of the following criteria are potentially eligible for benefits, regardless
of their date of entry:
1.
They are a qualified Resident Immigrant
2.
They meet one of the following military service criteria:
a. An honorably discharged veteran or person on active duty
b. On active duty in the Armed Forces of the U.S.
c. A spouse of a veteran or person on active duty who meets one of the following:
i. Is legally married to the veteran or person on active duty
ii. Is legally separated from the veteran or person on active duty
iii. Is a widowed spouse of the veteran or person on active duty and has not
remarried
Note: The applicant remains eligible regardless of whether they are living together or apart; the
veteran or active duty person can be a U.S. Citizen or a Resident Immigrant.
When verifying military service criteria, the following apply:
1.
An honorably discharged veteran of the Armed Forces of the U.S. must present an original
or notarized copy of the veteran's discharge papers
2.
To verify the active duty status an original or notarized copy of the applicant's current
orders or a military ID card (DD form 2 (active)) may be used
3.
Only full-time Air Force, Army, Navy, Marine or Coast Guard is eligible
4.
Any Reserve or National Guard duty is excluded
A spouse or single dependent child of a veteran or active duty alien must provide a document to
verify relationship along with military verification requirements.
Qualified USCIS Identification Cards
This section identifies qualified USCIS identification cards that applicants may provide to determine
whether they meet one of the qualified non-citizen requirements to receive benefits. Documents
cannot be EXPIRED.
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USCIS Identification Cards
The eligible ID cards listed in this section are as follows:
1.
I-94 Arrival/Departure Record
a. POTENTIALLY ELIGIBLE depending on the following:
i. I-94 admission stamp used, section of law/class-code annotations; Applicant
must also meet a qualified Non-Citizen Legal Resident Status criterion
identified in Section II-A. NOT ELIGIBLE for benefits when the document
lacks a registration number
2.
I-94 Parole Edition
a. POTENTIALLY ELIGIBLE depending on the following:
i. I-94 admission stamp used; section of law/class-code annotations; Applicant
must also meet a qualified Non-Citizen Legal Resident Status criterion
identified in Section II-A. NOT ELIGIBLE for benefits when the document
lacks a registration number.
3.
I-151 Alien Registration Card
a. POTENTIALLY ELIGIBLE – The I-151 is the original green card. Many however were
printed on blue paper; several versions of this card exist.
i. Applicants must also meet qualified Non-Citizen Legal Resident Status
criteria identified in Section II-A.
4.
I-551 Permanent Resident Card
5.
Visa Stamps in Foreign Passports – Eligible when all of the following occur:
a. The Visa is stamped "Processed for I-551, temporary Evidence of Lawful Admission
for Permanent Residence".
b. Neither the Visa NOR the passport have expired. The passport's expiration date is
normally found on the same page as the person's photograph.
Note: Applicants, who have expired, lost or otherwise cannot locate their immigration documents
from USCIS are responsible for contacting USCIS for replacement documents.
Note: Qualified Non-Citizen Legal Residents may have documents described as eligible. Case
managers must examine documents to establish their expiration date and cannot accept expired
documents.
Affidavit That Document(s) Is/Are True
An eligible applicant must execute a sworn affidavit stating that the documentation provided as
listed on this document during the verification process is true.
1.
Contractors who determine eligibility for these programs will be required to ensure that a
sworn affidavit is obtained in a way that does not delay the eligibility determination
process or add cost to the process for the applicant.
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2.
Eligible applicants are exempt from providing an affidavit only if they are 60 years of age
or older, if they are Tribal Members or if they are disabled or have an incapacity of the
body or mind which makes them unable to supply such affirmation.
Non-Qualified Immigrants
Consider the following Non-Citizens as Non-Qualified Immigrants. Documents include, but are not
limited to the following:
1.
I-94 (Non-citizens with this document may have either qualified or nonqualified status.
The admission stamp annotated on the card determines the non-citizen's status.)
2.
I-184 (Crewman Landing Permit)
3.
I-185 (Nonresident Alien Canadian Border Crossing Card)
4.
I-186 (Nonresident Mexican Border Crossing Card)
5.
I-444 (-Mexican Border Visitor Permit)
6.
I-586 (Nonresident Alien Border Crossing Card)
7.
l-688A (Employment Authorization)
8.
I-688 (Temporary Resident [This is the first card issued to non-citizens living in the U.S.
under the Amnesty Program of the Immigration Reform and Control Act of 1986.])
9.
I-688B (Employment Authorization [This is the second card issued to non-citizens under
the Amnesty Program of the Immigration Reform and Control Act of 1986.])
10.
I-689 (Fee Receipt-Non-citizens [With this card may have either qualified or nonqualified
status. The Provision of Law annotated on the card determines the non-citizen's status.])
11.
I-766 (Employment Authorization)
12.
DSP150 (Border Crossing Card [This card was introduced in 1997. Non-citizens with this
card may have either qualified or nonqualified status. The Provision of Law annotated on
the card determines the non-citizen's status.])
13.
Student Visa (This card was introduced in 1998)
Ineligible Alien ID Cards
When an applicant provides one of the following alien ID cards, they are INELIGIBLE for services and
the applicant must provide another eligible document. All these forms expired before January 24,
1990.
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1.
Any alien ID cards that are expired.
2.
I-181a Memorandum of creation of record of lawful permanent residence
3.
I-184 Alien crewman landing permit and identification card
4.
I-185 Non-resident alien Canadian border crossing card
5.
I-186 Non-resident alien Mexican border crossing card
6.
I-444- Mexican border visitor permit
7.
I-586 Non-resident alien border crossing card
8.
I-688 Employment authorization
9.
I-688A Employment authorization document
10.
I-688B Employment authorization document
11.
I-689 Fee receipt
12.
I-766 Employment authorization document
13. Non-resident border crossing card
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ATTACHMENT 1:
PAYMENT GUARANTEE
CONTACT INFORMATION
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PAYMENT GUARANTEE CONTACT INFORMATION
--ALL UTILITIES--
APS:
Online through the APS EAG system. Call the APS Caps Team (602) 371-6774 for
questions and assistance.
Email: guaranteeassistance@apsc.com
SRP:
Email: SRPEAG@srpnet.com
Phone: (602) 236-3003
Fax: (602) 914-8732
SWG:
Online through the SWG Portal. Please contact Southwest Gas directly for access
to the portal.
Email: SCA-SWGAgencies@swgas.com
Phone: (877) 967-9427
Fax: (866) 997-9427
GLOBAL WATER:
CustomerService@gwresources.com
Fax: (520) 568-6367
TEP:
Email: AgencyDesk@tep.com
Phone: 1-520-917-8418
Phasing out Fax Access
TRICO:
Email: memberservices@trico.coop
Phone: 1-520-744-2944 Option 4
Fax: 1-520-353-1640
UNISOURCE (Warm Spirit):
Email: AgencyDesk@uesaz.com
Phone: 1-866-628-5721
Fax: 1-866-870-5163
REQUIRED INFORMATION:
Guarantees should include the following information (see also the Policy section
on Payment Guarantee Process):
1. Account number
2. Customer name on account
3. Customer address
4. Date of guarantee and guarantee amount
5. Fund source (if possible)
6. Name of case worker requesting the guarantee
7. Name of organization requesting the guarantee
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ATTACHMENT 2:
PROGRAM SUMMARIES
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Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0
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WILDFIRE UTILITY ASSISTANCE
PROGRAM SUMMARY OVERVIEW
INFORMATION APPLIES TO:
All fund sources subcontracted to human service agencies
through Wildfire.
INCOME VERIFICATION
(When required by fund source):
All sources of household income received during the past 30
days, including the date of application must be accounted for
and verified.
SERVICE PERIOD:
A household may be assisted only once in a 12-month period for
each fund source, unless otherwise specified.
SUBSTITUTE SSN (if necessary):
Zip code + Birthday (for example: if zip code is 85203 and b-day is
May 1, 1980 then the substitute SSN will be 852-03-0501)
ACCEPTABLE CRISIS REASONS
(Program Summary will list requirements):
1. Loss or reduction of income or public assistance
benefits or a delay in receiving public assistance
benefits.
2. Unexpected and/or unplanned expense that caused a
lack of resources.
3. A condition that endangers the health and safety of
the household. See page 6 for more details/examples.
CLIENT FILES MUST CONTAIN:
1. Intake sheet with client info and name of Case
Manager
2. Verification document for ID of client
3. Citizenship verification (for HEAF and URRD only)
4. Utility bill, matching applicant service address or
receipt of fuel purchase
5. Income verification
6. Documents verifying crisis (if required by fund source)
7. Client affidavit form (if utilized)
8. Statement of truth/release of info, signed by the client
9. Copy of payment guarantee request
10. Additional documents required by fund source
(specifically repair/replace) as listed on Program
Summary
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PAYMENT GUARANTEE INFO:
Guarantees should include the following information:
1. Account number
2. Customer name on account
3. Customer address
4. Date of guarantee and guarantee amount
5. Fund source
6. Name of case worker requesting the guarantee
7. Name of organization requesting the guarantee
Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0
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ARIZONA PUBLIC SERVICE (APS)
CRISIS BILL ASSISTANCE PROGRAM SUMMARY
CAN PAY:
Current and past due charges, including reconnection fees or
establishment charges, incurred only at the client’s current
address. No credits can be given.
Cannot pay deposits. A deposit is not required if the customer is
on E-3.
Payments can be given to clients who are already enrolled in the
Budget Billing Program, even if a credit balance is already
showing on the account. The payment amount should cover the
current and upcoming month’s charges, as well as any
outstanding debt due to missed payments.
MAXIMUM GRANT AMOUNT:
$1,000.00. Customers may receive assistance twice in a 12-
month period.
ELIGIBILITY CRITERIA:
Household income must be at or below 200% of the current
Federal Poverty Level (FPL) guidelines.
Client must be the customer of record or a household member.
Disconnected accounts are eligible for assistance, but charges
incurred at former residences are not eligible.
CITIZENSHIP REQUIREMENT:
None
CRISIS:
Crisis reason must be stated on application. Documents verifying
crisis are required or the Case Manager may document in file that
documents verifying crisis were viewed.
PAYMENT GUARANTEE:
Online through the APS EAG system. Call the APS Caps Team
(602) 371-6774 for questions and assistance.
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GLOBAL WATER LOW INCOME RELIEF TARIFF
PROGRAM SUMMARY
WATER COMPANIES:
Santa Cruz Water Company (Pinal County) (Water – Maricopa,
Red Rock, Picacho Cove Utility in Coolidge)
Palo Verde Utilities Company (Pinal County) (Sewer –
Maricopa, Red Rock, Picacho Cove Utility in Coolidge)
Twin Hawks Utility (Pinal County) (Water – Marana)
Tortolita Water Company (Pima County) (Water – Marana)
Lyn Lee Water Company (Pima County) (Water- Marana)
Mirabell Water Company (Pima County) (Water – Three Points
in Tucson)
Francesca Water Company (Pima) (Water – Three Points in
Tucson)
Rincon Water Company (Pima County) (Water – Vail)
Las Quintas Serenas Water Company (Pima County) (Water –
Sahuarita)
Farmers Water Company (Pima County) (Water – Sahuarita,
Green Valley)
Belmont Water Company (Maricopa County) (Water Utility of
Greater Tonopah, Water Utility of Northern Scottsdale, Eagletail
Water Company)
CAN PAY:
Current and past due charges, deposits, late fees, reconnection
fees, service fees, returned payment fees, after hours service
fees (where applicable). Installation of a back-flow prevention
assembly if such assembly is required by tariff of the Global
Water Utilities. Credits can be given.
MAXIMUM GRANT AMOUNT:
$350.00 for water customers and $350.00 for sewer customers
in North Scottsdale, Tonopah and Eagletail.
$700.00 for customers in Maricopa and Red Rock.
Customers may be assisted more than once in a 12-
month period. The total amount of assistance within a 12-month
period cannot exceed $350.00 for water and $350 for sewer for
customers in North Scottsdale, Tonopah and Eagletail and
$700.00 for customers in Maricopa and Red Rock.
Clients can only receive assistance from one Customer Assistance
Program; listed under Eligibility Criteria on the next page.
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ELIGIBILITY CRITERIA:
Client must be customer of record and fall within one of the
following Customer Assistance Programs:
1) Low-Income Program: Household income must be at or
below 200% of the federal poverty guidelines. Clients must
not have a history of meter tampering or lock-cutting within
the last two years.
2) Deployed Service Member Program: Service member must
be on active duty for any of the armed forces, as defined by
10 U.S.C. 101(a)(4) and including any member of the
Reserves or National Guard called to active duty OR
Be deployed, on a deployment that is not a “permanent
change of station” and have a primary residence in the
Company’s service area.
Each service member’s eligibility must be verified based on
written orders from the service member’s command.
3) Disabled Military Veteran Program: Client must have been
on active duty for any of the armed forces, as defined by 10
U.S.C. 101(a)(4); including any member of the Reserves or
National Guard called to active duty AND been honorably
discharged from the armed forces AND have a permanent
disability rating related to their military duty service, as
demonstrated by a medical discharge or other written
documentation from the US Department of Defense or
Department of Veteran Affairs.
4) Furloughed Worker Program: Client must have been
employed in good standing with an employer AND provide
written evidence that the person has been temporarily laid
off, subject to recall or furloughed by an employer.
5) Medical Hardship Program: Customers, customers’ spouse
or customers’ qualifying dependent may have experienced a
medical issue resulting in unexpected medical costs. To
qualify the person must – be qualified for Social Security
Disability Benefits, as evidenced by notice from the SSA OR
be qualified for other short-term or long-term disability
insurance benefits, as evidenced by a letter from the insurer
OR have experienced hospitalization of more than five (5)
days within the last year OR provide documentation that the
customer, customer’s spouse, or a person claimed as a
dependent on the customer’s federal tax return, is currently
on leave under the Family and Medical Leave Act of 1993, as
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amended 29 U.S.C 2601 et seq., or has been on such leave
within the past year.
CITIZENSHIP REQUIREMENT:
None.
CRISIS:
A crisis reason is not necessary. Required documents are
outlined in the Customer Assistance Programs; listed under
Eligibility Criteria.
PAYMENT GUARANTEE:
Email to: customerservice@gwresources.com; must indicate
which Customer Assistance Program was utilized.
Fax: (520) 568-6367; must indicate which Customer Assistance
Program was utilized.
Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0
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HEAT RELIEF INITIATIVE
PROGRAM SUMMARY
The Emergency Heat Relief program is a response to the state of emergency declared by the governor of
Arizona in 2023. It is the result of fundraising efforts by Wildfire and generous donations from utility
companies, foundations, HVAC contractors and others throughout the state of Arizona. The funds are
designated for replacements, or new installations, of HVAC units.
CAN PAY:
Replacement or installation costs for HVAC units, including any
duct and electrical work necessary for job completion. Follow-
up costs to educate and assist households with extended
warranty registration and system maintenance to ensure
longevity. Mini-split units are allowable, while window and
portable units are not, however they are potentially allowable
under URRD.
Priority should be given to households in immediate danger of
heat-related illnesses or deaths. Funds from this program can
be utilized in conjunction with other sources, especially in cases
where additional work must be performed later to ensure long-
term sustainability of the HVAC replacement.
MAXIMUM GRANT AMOUNT:
$10,000.00 per household. This amount can be exceeded if a
minimum number of households (specified by Wildfire in the
program year contract) are served with these funds by the
participating partner during the program year.
ELIGIBILITY CRITERIA:
Household income must be at or below 200% of the current,
Federal Poverty Level (FPL) guidelines. Exceptions can be made
with Wildfire approval.
CRISIS:
Households in immediate, heat-related danger should be
prioritized.
CITIZENSHIP REQUIREMENT:
None
ADDITIONAL DOCUMENTS:
(1) Invoice for total costs from a pre-approved contractor; (2)
client statement indicating that replacement has been
completed appropriately; (3) documentation of post-
replacement inspection by qualified staff or contractor.
Wildfire will be conducting qualitative and quantitative data
collection for ongoing fundraising efforts. Participating partners
will be required to assist in these efforts
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SALT RIVER PROJECT (SRP)
BILL ASSISTANCE PROGRAM SUMMARY
CAN PAY:
Current and past due charges, reconnection fees, establishment
charges, deposits and balances from a previous SRP address.
Credits can be given to clients under circumstances where the
Case Manager determines that the funds are necessary for the
financial stability of the client. Credits must be given only to
clients whose circumstances truly warrant them. In these
situations, case notes should outline the details of the decision-
making process.
Payments can be given to clients who are already enrolled in the
Budget Billing program, even if a credit balance is already
showing on the account. The payment amount should cover the
current and upcoming month’s charges, as well as any
outstanding debt due to missed payments.
Payments for clients enrolled in the M-Power Program should be
enough to cover outstanding debt and the next 30 days of energy
usage, based on the Customer Usage Report (available from SRP),
taking into account upcoming weather conditions.
MAXIMUM GRANT AMOUNT:
$600.00. Customers can receive assistance once in a 12-month
period.
ELIGIBILITY CRITERIA:
Household income must be at or below 200% of the current
Federal Poverty Level (FPL) guidelines.
Client must be the customer of record or a household member.
CITIZENSHIP REQUIREMENT:
None
CRISIS:
Crisis reason must be stated on application. Documents verifying
crisis is NOT required. An inability to pay a bill is considered a
crisis.
PAYMENT GUARANTEE:
Email:
SRPEAG@srpnet.com
Phone:
(602) 236-3003
FAX:
(602) 914-8732
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SOUTHWEST GAS LIEC
BILL ASSISTANCE PROGRAM SUMMARY
CAN PAY:
Current and past due charges, including deposits. Up to 25% of
the agency’s allocated funds can be used to assist clients with
deposits.
A client may receive a credit under circumstances where the case
manager determines that the funds are necessary for the
financial stability of the client. Credits must be given only to
clients whose circumstances truly warrant them. In these
situations, case notes should outline the details of the decision-
making process.
This may include assisting customers who have historically
disconnected their gas in the summer, only to have a
reconnection fee in the fall that they might have trouble paying.
By crediting them in the spring/summer months, this can allow
them to avoid such fees.
MAXIMUM GRANT AMOUNT:
$400.00. Customers can receive assistance once in a 12-month
period.
ELIGIBILITY CRITERIA:
Household income must be at or below 200% of the current
Federal Poverty Level (FPL) guidelines.
Client must be the customer of record or apply for assistance by
named proxy.
CITIZENSHIP REQUIREMENT:
None
CRISIS:
Not required.
PAYMENT GUARANTEE:
Email: SCA-SWGAgencies@swgas.com
Phone: (877) 967-9427
Fax: (866) 997-9427
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SOUTHWEST GAS ENERGY SHARE – BILL ASSISTANCE
PROGRAM SUMMARY
CAN PAY:
Current and past due charges, including deposits, late charges,
reestablishment fees, and other related costs or fees.
A client may receive a credit under circumstances where the case
manager determines that the funds are necessary for the
financial stability of the client. Credits must be given only to
clients whose circumstances truly warrant them. In these
situations, case notes should outline the details of the decision-
making process.
This may include assisting customers who have historically
disconnected their gas in the summer, only to have a
reconnection fee in the fall that they might have trouble paying.
Providing a credit in the spring/summer months can allow them
to avoid such fees.
MAXIMUM GRANT AMOUNT:
$400.00.
Customers
may
receive assistance multiple times in a 12-month period, provided
that the total assistance does not exceed $400 within that period.
ELIGIBILITY CRITERIA:
Clients must have household income at or below 200% of the
federal poverty guidelines, a verified financial crisis or an
unexpected financial difficulty.
Client must be the customer of record or a household member.
CITIZENSHIP REQUIREMENT:
None
CRISIS:
Not required for clients whose household income is at or below
200% of the federal poverty guidelines. For clients whose
household income is above 200% of the federal poverty
guidelines, crisis reason must be stated on application.
Documents verifying financial crisis are required.
PAYMENT GUARANTEE:
Email: SCA-SWGAgencies@swgas.com
Phone: (877) 967-9427
Fax: (866) 997-9427
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SOUTHWEST GAS ENERGY SHARE – REPAIR/REPLACEMENT
PROGRAM SUMMARY
CAN PAY:
Costs associated with repairing natural gas equipment or
replacement costs in cases where repair is impossible, or repair
costs would exceed replacement costs.
Costs associated with gas line repair or relocation in conjunction
with the Southwest Gas Customer-Owned Yard Line (COYL)
Program.
MAXIMUM GRANT AMOUNT:
$2,000.00. Customers may
receive assistance multiple times in a 12-month period, provided
that the total assistance does not exceed $2,000 within that
period; funds can only be used once in conjunction with the COYL
program.
ELIGIBILITY CRITERIA:
Clients must have household income at or below 200% of the
current Federal Poverty Level (FPL) guidelines, OR a condition
that endangers the health and safety of the household.
Client must be the customer of record or a household member.
For appliance repair/replacement: Proof of ownership of the
appliance is required.
For gas line repair/replacement in conjunction with COYL
program: Proof of client participation in COYL program
(completed Southwest Gas Meter Relocation Agreement, signed
by client and Southwest Gas representative) is required.
CITIZENSHIP REQUIREMENT:
None
CRISIS:
Not required for clients whose household income is at or below
200% of the federal poverty guidelines. Clients whose household
income is above 200% may be assisted if they are experiencing a
condition that endangers the health and safety of household
members. Crisis reason must be stated on application.
Documents verifying crisis are NOT required.
For appliance repair/replacement: (1) Invoice for total costs from
pre-approved contractor; (2) Client statement indicating that
repairs/replacements have been completed is required.
For gas line repair/replacement in conjunction with COYL
program: Completed Meter Relocation Agreement, signed by
client and Southwest Gas representative is required.
ADDITIONAL DOCUMENTS
REQUIRED FOR CLIENT FILE:
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Instructions for Assisting Clients in the Southwest Gas
Customer-Owned Yard Line (COYL) Program
Using Southwest Gas Energy Share – Repair/Replacement Funds
The COYL program is operated by Southwest Gas and is a service provided to certain Southwest Gas
customers who elect to allow their gas meters to be relocated at the expense of Southwest Gas.
Southwest Gas Customers who are participating in the COYL program may be eligible for additional
assistance with Southwest Gas Energy Share – Repair/Replacement funds under the following
circumstances:
1. A gas leak at the customer’s residence was discovered during the meter relocation process
AND/OR
2. The meter cannot be relocated to the original residence entry point and requires additional
plumbing to complete the installation.
In these cases, the client would incur additional costs, not covered by the COYL program. These clients
can be assisted with Southwest Gas Energy Share – Repair/Replacement funds if otherwise eligible. In
order to assist these clients, their participation in the COYL program must be verified using a copy of
their completed Meter Relocation Agreement, signed by both the client and a Southwest Gas
representative.
Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0
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TRICO ASSISTANCE
PROGRAM SUMMARY
CAN PAY:
Utility bills, rent, mortgage, food, medical bills and other emergency
needs at the discretion of the Participating Agency. Replacement of
appliances only in cases where repair cost would exceed replacement
cost. For repair/replacement, the applicant must be the owner of the
appliance or home, as applicable.
MAXIMUM GRANT AMOUNT: $800.00. Customers may receive assistance multiple times in a 12-
month period, provided that the total assistance does not exceed $800
within that period
ELIGIBILITY CRITERIA:
Household income must be at or below 200% of the federal poverty
guidelines.
Households must be in Trico service area; within Pima, Pinal and Santa
Cruz Counties.
A Trico customer must reside in the household.
CITIZENSHIP REQUIREMENT:
None.
CRISIS:
Crisis reason must be stated on application. Documents verifying crisis
are NOT required.
ADDITIONAL DOCUMENTS:
Copy of the rental agreement or a note from the landlord for utility
costs included in rent, if applicable.
For repair/replace, proof of ownership of the appliance or home.
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TUCSON ELECTRIC POWER (TEP) BILL ASSISTANCE
PROGRAM SUMMARY
CAN PAY:
Current and past due charges.
Can pay deposits, reconnect fees and establishment charges.
No credits can be given on any accounts.
MAXIMUM GRANT AMOUNT:
$800.00. Customers can receive assistance once in a 12-month
period.
ELIGIBILITY CRITERIA:
Household income must be at or below 200% of the current
Federal Poverty Level (FPL) guidelines.
Client must be the customer of record or a household member.
CITIZENSHIP REQUIREMENT:
None
CRISIS:
Crisis reason must be stated on application. Documents
verifying crisis are NOT required.
PAYMENT GUARANTEE:
Email: AgencyDesk@tep.com
Phone: 1-520-917-8418 Option 4
Fax: 1-520-571-4026
Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0
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UNISOURCE ELECTRIC (UNSE) BILL ASSISTANCE
PROGRAM SUMMARY
CAN PAY:
Current and past due charges.
Can pay deposits, reconnect fees and establishment charges.
No credits can be given on any accounts.
MAXIMUM GRANT AMOUNT:
$800.00. Customers can receive assistance once in a 12-month
period.
ELIGIBILITY CRITERIA:
Household income must be at or below 200% of the current
Federal Poverty Level (FPL) guidelines.
Client must be the customer of record or a household member.
CITIZENSHIP REQUIREMENT:
None
CRISIS:
Crisis reason must be stated on application. Documents
verifying crisis are NOT required.
PAYMENT GUARANTEE:
Email: AgencyDesk@uesaz.com
Phone: 1-866-628-5721
Fax: 1-866-870-5163
Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0
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UTILITY REPAIR REPLACEMENT AND DEPOSIT (URRD)
PROGRAM SUMMARY
The Utility Repair, Replacement and Deposit (URRD) fund was established by state law (A.R.S.
§46-731) to provide assistance to low income individuals in crisis situations with deposits for
utility services and to make needed repairs and/or replacements to existing utility related
appliances or systems. In January 2007, A.R.S. §46-731 was revised to require abandoned
deposits to be administered by a qualified fuel fund entity.
CAN PAY:
Deposits for utility services (electric, gas, water, telephone)
Repairs to existing utility related appliances or systems
Replacement of existing utility related appliances only in cases
where repair costs would exceed replacement costs or when an
appliance is found to be inoperable with repairs. Replacement
appliances must have an Energy Efficient Star Rating.
Guidelines for Deposits
CAN PAY:
Deposits for any utility company. Utility deposit included in a
client’s rental agreement and collected along with rental
payments are eligible for assistance.
MAXIMUM GRANT AMOUNT:
$4,500.00 Customers can receive assistance once in a 12-month
period.
ELIGIBILITY CRITERIA:
Household income must be at or below 200% of the current
Federal Poverty Level (FPL) guidelines.
CRISIS:
None needed.
CITIZENSHIP REQUIREMENT:
Primary applicant must be U.S. citizen or legal resident.
ADDITIONAL DOCUMENTS:
Citizenship/Legal Resident status verification for primary
applicant
Copy of the rental agreement or a note from the landlord for
utility costs included in rent.
Payment guarantees made to the designated utility company
(page 34).
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Guidelines for Repair/Replacement
Ownership:
The applicant must be the owner of the appliance or system to be repaired and/or replaced.
The following documents can be used to verify ownership:
1. Purchase receipt provided by the client, or
2. Statement of ownership, signed by the client
A qualified individual of the agency, vendor, or trained weatherization contractor may complete
inspection of the needed repair and/or replacement.
Eligible Appliance & Systems
Water Heater
Cooking Stove
Microwave
Furnaces
Air Conditioner
Home Telephone (landline only)
Evaporative Coolers
Refrigerators
Washer/Dryers
Electrical Panels
HEPA Filters
Ineligible Appliances & Systems
Television
Radios
VCRs
Hair Dryers
Blenders
Cable TV
Satellite Receivers
Water Softener
Dishwasher
Water Pump
Water Tank
Pressure Tank
For any appliance repair and/or replacement not listed on the list of eligible appliances, please
contact Wildfire at (602) 604-0640.
MAXIMUM GRANT AMOUNT:
$4,500.00 Customers can receive assistance once in a 12-month
period.
ELIGIBILITY CRITERIA:
Household income must be at or below 200% of the current
Federal Poverty Level (FPL) guidelines.
The applicant must be the owner of the appliance or system to
be repaired and/or replaced.
A qualified individual of the agency may conduct inspection of
the needed repair and/or replacement.
CRISIS:
Crisis reason must be stated on application. Documents
verifying crisis are NOT required.
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CITIZENSHIP REQUIREMENT:
Primary applicant must be a U.S. citizen or legal resident.
ADDITIONAL DOCUMENTS:
Citizenship/Legal Resident status verification for primary
applicant
For appliance repair/replacement: (1) Proof of ownership of
appliance or system (receipt or client statement is acceptable);
(2) Invoice for total costs from pre-approved contractor; (3)
Client statement indicating that repairs/replacements have been
completed and are satisfactory.
PAYMENT FOR REPAIR/REPLACEMENT: After completion of work, inspection, written confirmation from
client that work was completed and is satisfactory, and receipt of
appropriate documentation, such as an invoice with a client’s
signature.
Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0
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WARM SPIRIT ELECTRIC & GAS FUND PROGRAM SUMMARY
(Funds Provided by UniSource Energy)
CAN PAY:
Utility bills, including current and past due charges, deposits,
late fees, service establishment and reconnection fees.
No credits can be given on any accounts.
MAXIMUM GRANT AMOUNT:
$500.00
ELIGIBILITY CRITERIA:
Household income must be at or below 200% of the current
Federal Poverty Level (FPL) guidelines.
Client must be the customer of record or a household member.
CITIZENSHIP REQUIREMENT:
None
CRISIS:
Crisis reason must be stated on application. Documents
verifying crisis are NOT required.
PAYMENT GUARANTEE:
Email: AgencyDesk@uesaz.com
Phone: 1-866-628-5721
Fax: 1-866-870-5163
Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0
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ATTACHMENT 3:
SITE VISIT CHECKLIST
Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0
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AGENCY FUND SOURCE CHECKLIST
Wildfire recommends agencies be “audit ready” by completing regular internal audits or file reviews on
utility assistance files in preparation for future Wildfire Site Visits.
Items for review must be easily accessible for Wildfire staff conducting visits, whether contents are
pulled out of the file or tabbed in accordance with the checklist.
Documentation on File:
Yes No
Notes
ID verification of applicant
Income verification for all household
members during previous 30 days; FPL%
Current utility bill with address that
matches applicant & service address;
acceptable applicants
Crisis documentation
Signed affidavit for any and all missing
documents
Signed statement of truth and release of
information
Copy of payment guarantee
For URRD: Documentation of citizenship
or lawful presence for primary applicant
(page 21 of the manual)
For repair/replace: Proof of ownership for
appliance repair/replace
For repair/replace: Verification of costs for
appliance repair/replace
For repair/replace: Statement of
completion signed by client
Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0
Exhibit B
Home Energy Assistance Fund
Effective July 1, 2024 - June 30, 2025
Federal Poverty Guidelines (FPG) - Income thresholds for the last 30 days by percent of FPG
Household Size
Percent of Poverty
1
2
3
4
5
6
7
8
9
10
For each
additional
member add:
100%
$1,255
$1,703
$2,151
$2,599
$3,047
$3,495
$3,943
$4,391
$4,839
$5,287
$448
150%
$ 1,882
$ 2,555
$ 3,227
$ 3,900
$ 4,572
$ 5,245
$ 5,917
$ 6,590
$ 7,262
$ 7,935
$ 673
200%
$ 2,510
$ 3,407
$ 4,303
$ 5,200
$ 6,097
$ 6,993
$ 7,890
$ 8,787
$ 9,684
$ 10,581
$ 897
Federal Poverty Guidelines (FPG) - ANNUAL income thresholds
Household Size
Percent of Poverty
1
2
3
4
5
6
7
8
9
10
For each
additional
member add:
100%
$15,060
$20,440
$25,820
$31,200
$36,580
$41,960
$47,340
$52,720
$58,100
$63,480
$5,380
150%
$22,590
$30,660
$38,730
$46,800
$54,870
$62,940
$71,010
$79,080
$87,150
$95,220
$8,070
200%
$30,120
$40,880
$51,640
$62,400
$73,160
$83,920
$94,680
$105,440
$116,200
$126,960
$10,760
5.30.24
Docusign Envelope ID: 0F3C1D87-9545-48A6-A59C-96E0191742B0