APPLICATION PROCESS
Please complete the application and submit it by the methods listed below along with the following items:
IF APPLYING FOR ANY HOPWA ASSISTANCE…
_____ COMPLETED APPLICATION Packet
_____ COPY OF PHOTO ID(S) –a driver’s licensestate IDatfor all household members over theage of 1.
_____ COPY OF PROOF OF MEDICAL STATUS – et results, lab results showing a Viral Load, or statement froyour
medical provider (included) for all HIV+ household members. If you do not have this information, it must be
obtained from your physician’s office.
_____ PROOF OF INCOME for all household members – copies of at paystubs if working (2 paystubs if paid biweekly and
monthly; 4 paystubs if paid weekly), or a copy of Social Security Awards Letter if receiving retirement, disability,
or SSI. If there any household members over the age of 18 with no income, each member must complete the
“Zero Income Affidavit” form.
IF APPLYING FOR SHORT-TERM RENTAL, MORTGAGE, AND UTILITY ASSISTANCE ONLY
…
_____ C
OPY OF CURRENT LEASE OR
A RECENT MORTGAGE STATEMENT – This documentation must be submitted regardless if
an applicant is seeking assistance with rent or mortgage.
_____ C
OPY OF UTILITY BILL (if applying for utility assistance) – Utilities must be in a household member’s name. You
must include the entire bill. Termination or disconnect notices CANNOT be accepted.
PLEASE NOTE
: Incomplete applications CANNOT be processed and will be returned to you for additional information.
Based upon the nature of your emergency, you may be REQUIRED to provide additional information before receiving
assistance.
If you have any questions, please call the office at (870) before submitting the application.
We look forward to working with you.
iling address:
rkansas Supportive Services
o
oesoro
ocumentation may be sent via fax and
email to dm tins .
Fax: (870)
mil [email protected]