Smud Assistance Application Form PDF Details

Understanding the Sacramento Municipal Utility District's Energy Assistance Program Rate (EAPR) can significantly reduce the financial burden of utility bills for eligible households. This beneficial program requires applicants to provide detailed information, starting with the basics like the applicant's name and address, extending to the number of residents, and most importantly, the total monthly household income. A pivotal part of the application process involves submitting copies of income documentation for all household members, a crucial step to verify eligibility. The EAPR offers a structured guideline for income eligibility, tailored to accommodate different household sizes, requiring information about gross income, which includes any form of earnings before deductions. The assistance form also necessitates a declaration and signature from the applicant, acting as consent for eligibility verification and the sharing of the provided information with relevant authorities, while also allowing for the necessary adjustments to the applicant's utility rate schedule. Encouraging participation, the form outlines the conditions underpinning eligibility: the SMUD bill must be in the applicant's name, the income threshold must meet specific criteria, and the application must be fully completed, including the required documentation. Gross household income is broadly defined to encompass various sources, be it wages, benefits, or any other monetary support, ensuring a comprehensive assessment of an applicant's financial status. As outlined, the program mandates periodic re-application, indicating a commitment to adapt to changing household incomes or circumstances, thus maintaining integrity and relevance in its assistance efforts.

QuestionAnswer
Form NameSmud Assistance Application Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameshow to form smud, application energy, smud, smud financial assistance

Form Preview Example

Application for Energy Assistance Program Rate (EAPR)

 

CUSTOMER INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How to Apply

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Enter the number of people living in your

 

 

 

 

Last Name

First Name

 

 

 

 

 

home.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Enter the total monthly income for your

 

 

 

 

 

 

 

 

 

 

 

 

 

 

household.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Attach a copy of your income documentation.

 

 

 

 

Mailing Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Sign and date the application, then mail

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

it along with your income documentation to:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

State

Zip

 

Sacramento Municipal Utility District

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EAPR, M.S. A203

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P.O. Box 15830

 

 

 

 

SMUD Account Number

Or: Name of your Mobile Home Park

 

 

 

 

 

 

Sacramento, CA 95852-1830

 

 

 

 

 

 

 

(if your electricity is submetered)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. HOUSEHOLD INCOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please complete the following:

 

 

 

 

 

Eligibility Guidelines (effective June 1, 2014)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Persons in

 

Monthly Income

 

Annual

 

 

 

 

Number of people living in your home,

 

 

 

 

 

 

 

Household

 

 

Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

including adults and children under 18:

 

 

 

people

 

 

 

 

 

 

 

 

 

 

 

 

 

1-2

 

$ 2,622

 

 

$ 31,460

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Monthly Household Income (Gross): $

 

 

 

 

 

 

3

 

$ 3,298

 

 

$ 39,580

 

 

 

 

 

 

 

 

 

 

4

 

$ 3,975

 

 

$ 47,700

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

$ 4,652

 

 

$ 55,820

 

 

 

2. INCOME DOCUMENTATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

$ 5,328

 

 

$ 63,940

 

 

 

 

Please attach copies of your income documentation

 

 

 

 

 

 

 

Each Additional

 

 

 

 

 

 

 

 

for everyone living in your home. The documents will

 

 

 

 

 

NOT be returned. Examples of income documentation

Members

 

$ 677

 

 

$ 8,120

 

 

 

 

include, but are not limited to:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4 weeks of dated paystubs from within the past 2 months

Benefit letters such as SSI, EDD, Welfare, Foodstamps, Pensions, Workers Compensation, etc.

Most recent individual Income Tax Return (1040 pages 1 & 2 - adjusted gross income and signature required)

If you have any questions regarding appropriate income documentation, please visit our website at www.smud.org/financialassistance for more information or call 1-888-742-7683 for assistance.

3.DECLARATION AND SIGNATURE

The information on this application will be used to decide and verify my eligibility for help. My signature gives consent for this information to be shared with other ofices of the Federal, State, and County Governments, with my utility company, and with other utilities or their agents to enroll me in their assistance programs. I permit the proper change to my rate schedule and consent to annual eligibility veriication. I declare, under penalty of perjury, that the information on this application is true and correct.

X

Signature (person whose name appears on SMUD bill)

 

Date

©SMUD-2743 (without flyer) 4/14 Forms Management

To participate in EAPR:

Your SMUD bill is in your name and you live at the address that will receive the discount.

Your gross (before taxes) household income* is no more than the amounts listed in the eligibility guidelines on the front.

Your application is completed with your name, address, number of people living in your

home, monthly gross income, your signature and the date, and copies of your income documents.

*Gross household income is all money and non-cash beneits available for living expenses, from all sources, both taxable and nontaxable, before deductions, for all people who live in the home. This includes but is not limited to:

Wages or Salaries

Social Security, SSI, SSP, SSDI

Interest and/or Dividends from:

Veteran’s Beneits

Savings Accounts

Pensions

Stocks or Bonds

Annuities

Retirement Accounts

Insurance Settlements

Unemployment Beneits

Legal Settlements

Rental or Royalty Income

TANF (AFDC)

School grants, scholarships (or

Food Stamps

other aid used for living expenses)

Child Support

Proit from Self-Employment

Spousal Support

Disability Payments

Cash and/or Other Income

Workers Compensation

 

EAPR FAQs

Will my income documents be returned to me?

We’re not able to return your original documents, so please send COPIES of any income/beneit documentation with your application.

Once a completed and signed application with income documents are received by SMUD how long will it take to be processed?

A completed application package is usually processed within 2 – 4 weeks of being received. After you’ve been enrolled, the Energy Assistance Program Discount will be printed as a line item on your SMUD bill each month.

If I have more than one account in my name, can I have the EAPR discount on all of them?

No, the discount is only applied to your primary residence.

How long will I receive the discounted rate?

We typically ask customers to re-apply every 1 to 2 years. When it’s time to re-apply, we’ll mail a request to you, and the letter will explain all requirements.

What should I do if I no longer qualify for the discount?

If your income or circumstances change, and you no longer qualify, please give us a call at 1-888- 742-7683 to update your account.

© SMUD-2743 (Reverse) 10/11 Forms Management