Scecomcarerecert PDF Details

Do you need to recertify your Scecomcare coverage? If so, the Scecomcarerecert Form is a great resource to help you through the process. This form includes all of the information you need to know about recertifying, including how to submit your application and what documentation you will need. Make sure to read through the form carefully to ensure a smooth recertification process.

Here is some information that might be helpful if you're seeking to find out just how long it'll take you to fill out scecomcarerecert and how many PDF pages it includes.

Form NameScecomcarerecert
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other names 61523-E

Form Preview Example

Southern California Edison


Cal. PUC Sheet No.


Rosemead, California

(U 338-E)

Cancelling Revised

Cal. PUC Sheet No.


Sheet 1



(Single Family Dwelling with SCE Meter)

Form 14-803

(To be inserted by utility)

Issued by

(To be inserted by Cal. PUC)



Caroline Choi

Date Filed

Apr 5, 2017

Decision 04-02-057

Senior Vice President


Jun 1, 2017













For questions call 1-800-447-6620 or visit us

online at






Service Account Number 3@@SERV_ACCT_NUM


We recently sent you a notice to re-certify your eligibility to participate in the California Alternate Rates for Energy (CARE) or Family Energy Rate Assistance (FERA) program. For the past few years, you have received a discount on your Southern California Edison (SCE) electric bill through your participation in the CARE or FERA program. In order to remain enrolled in the program, you will need to re-certify your eligibility within 45 days from the date of this second notice.

You may re-certify your eligibility online, by phone or mail:

Online: Recertify on line by logging onto

Phone: Call our toll-free automated re-certification number at 1-800-890-1245 [TTY 1-800-352-8580] Please be prepared to provide the following:

Total annual combined household income. This is income from all sources, for every member of your household receiving income (taxable or non-taxable)

Total number of people in your household

Mail: Sign and complete the Certification Form on the reverse of this notice, and return it in the postage-paid envelope provided.

There are two ways to qualify:

You can qualify for CARE if you or someone in your home participates in at least one of the eligible public assistance programs. (See Section 3a on the back of this form) OR

You can also qualify for CARE or FERA if you meet the income guideline qualifications listed in the chart below.

Please allow at least 30 days for processing. If you do not qualify for either program, please advise us by calling 1-800 798-5723 or by checking the appropriate box on the Certification Form.




Maximum Household Income -- Effective as of June 1, 2017

Number of Persons in Household

Total Combined Annual Income




1 - 2

up to $32,480

Not eligible


up to $40,840

$40,841 - $51,050


up to $49,200

$49,201 $61,500


up to $57,560

$57,561 $71,950


up to $65,920

$65,921 $82,400


up to $74,280

$74,281 $92,850


up to $82,640

$82,641 $103,300

Each additional person


$8,360 $10,450












Daytime Telephone Number (Please include area code)


Cell phone

Email Address:

Check here ONLY IF YOU NO LONGER QUALIFY to participate in either the CARE or FERA rate assistance program. Your account will be removed from the CARE/FERA program. If you checked this box, please proceed to Section 4; sign

and date at the bottom, then mail this form in the postage paid envelope provided.

Check here if TTY User / Hearing Impaired (English only)

1HOUSEHOLD INFORMATION: Total Number of persons in household (Do Not Leave Blank)

Adults_________ Children________ Total (Adult + Children) ________

2PUBLIC ASSISTANCE PROGRAM ELIGIBILITY: Please check () ALL programs you participate in. If you do not participate in any of the programs in this section, then be sure to complete Section 3.

Medi-Cal/ Medicaid

CalFresh/SNAP (Food Stamps)

CalWorks (TANF)/

Tribal TANF


Medi-Cal for Families (Healthy Families A&B)


Supplemental Security Income (SSI) National School Lunch Program (NSLP) Bureau of Indian Affairs General Assistance Head Start Income Eligible (Tribal Only)

3INCOME ELIGIBILITY: Please provide your total gross annual household income, and check () all income sources

Total combined gross annual household income:$










.00 per year (round to the nearest dollar)

For example: Monthly income X 12 months = gross











annual household income



Wages and/or Profits from Self-

Scholarships, Grants, or Other

Social Security


Aid Used for Living Expenses













Unemployment Benefits

Insurance or Legal Settlements

 Disability or Workers’


Interest or Dividends

Spousal or Child Support

from Savings, Stocks,

Compensation Payments

Cash and/or Other Income

Bonds, or Retirement

Rental or Royalty Income




4CARE/FERA Declaration: I state that the information I have provided in this application is true and correct. I understand

that I may be requested to provide updated documentation of eligibility at any time and agree to do so regardless of how I initially became eligible for the discount. I agree to inform Southern California Edison Company if I no longer qualify to receive the discount. I understand that if I receive the discount without qualifying for it, I may be required to pay back the discount I received. I understand that SCE can share my information with other utilities or their agents to enroll me in their assistance programs.

Customer Signature (same name as listed on the account): ___________________________________ Date: _______________

Customer Name (please print): ____________________________________________________

Indicate if you are a guardian or have Power-of-Attorney for the above account and provide a notarized copy of the Power-of-Attorney document.

By checking this box, I confirm the information provided is accurate, and agree to receive calls at the above number, through an automatic-dialing announcing device (ATDS), or a pre-recorded message from, or on behalf of, Southern California Edison for rebates, savings, or other low-income qualified program information. I understand that consent to receiving these calls is not required to enroll in this income-qualified program and that message and data rates may apply.

Return this form to Southern California Edison in the postage paid return envelope provided, or mail directly to:

Southern California Edison, CARE Dept., P.O. Box 9527, Azusa, CA 91702-9932

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