EXHIBIT A HEAF POLICY MANUAL FY24.PDF

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Wildfire 
Home Energy Assistance Fund  
Policy Manual 
 
FY 2024 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EXHIBIT A

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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 
Cooperation .................................................................................................................................................... 12 
Confidentiality ................................................................................................................................................ 12 
Non-Discrimination Policy ............................................................................................................................ 13

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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 ................................................................................................... 54

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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 
(up to and including the day of application) of countable income for each household member

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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 (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. 
 
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

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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. 
 
20. VETERANS ADMINISTRATION BENEFITS (VA): Retirement, Survivors, Disability, and 
Educational Benefits are paid to veterans and their dependents or survivors. Only the

18 
 
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 
 
16. Income Tax Refund

19 
 
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 
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.)

20 
 
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))

21 
 
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.

22 
 
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.

23 
 
 
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

24 
 
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:

25 
 
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

26 
 
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  
 
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.

27 
 
 
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)  
 
1. 
I-94 with the words: CUBAN/HAITIAN ENTRANT UNDER 212(D) OF THE INA (Eligible for 
Benefits)

28 
 
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  
 
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.

29 
 
 
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.  
 
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:

30 
 
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.  
 
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.

31 
 
 
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.  
 
1. 
Any alien ID cards that are expired.  
 
2. 
I-181a Memorandum of creation of record of lawful permanent residence

32 
 
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

33 
 
 
ATTACHMENT 1:  
 
PAYMENT GUARANTEE  
CONTACT INFORMATION

34 
 
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

35 
 
 
 
 
 
ATTACHMENT 2:  
 
PROGRAM SUMMARIES

36

37 
 
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

38 
 
 
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

39 
 
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.

40 
 
GLOBAL WATER LOW INCOME RELIEF TARIFF  
PROGRAM SUMMARY 
 
WATER COMPANIES: 
Santa Cruz Water Company (Water – Maricopa)   
Palo Verde Utilities Company (Sewer – Maricopa)   
Water Utility of Greater Tonopah  
Water Utility of Northern Scottsdale  
 
Eagletail Water Company 
 
Global Water – Red Rock Utilities 
 
  
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 the year 
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. 
 
   
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.

41 
 
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 
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.

42 
 
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

43 
 
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

44 
 
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

45 
 
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 is 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:

46 
 
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.

47 
 
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.

48 
 
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

49 
 
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

50 
 
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). 
  
 
Guidelines for Repair/Replacement

51 
 
 
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.  
CITIZENSHIP REQUIREMENT: 
Primary applicant must be a U.S. citizen or legal resident.

52 
 
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.

53 
 
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

54 
 
 
 
 
 
 
 
 
ATTACHMENT 3:  
 
SITE VISIT CHECKLIST

55 
 
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 
  
  
  
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