I consent to the verification of the information contained on the application including ALL household income, any benefits received from the Passport to Services/TANF Program at the Department of Human Services of the Tribal TANF Program, Social Services (Disability & Retirement) and all other sources of all income eligibility. I waive my rights to keep these records confidential from Redding Rancheria Tribal Government LIHEAP in order to administer this program. Any adult in the claim must provide proof of income and sign the application. Exception: Staff may determine exceptions for married and non-married households and/or if a catastrophic (fire, flood, earthquake, etc.,) event occurs.
I have read and understand the consent on income information, confidentiality waiver and penalty provision on this application. I understand and agree that you may contact any and all listed sources of income for verification as necessary.
I certify, by signing this application, that all information given is true and accurate. I am also aware that giving false information may subject myself of access to this program for up to three (3) years.