Emergency Assistance Application

Please Note: Payment for deliverable fuel will not be made if, upon delivery, it is confirmed you have more than 25% remaining in your tank. You will then be responsible for the cost of delivery. 

Acceptable Proof Of Income

Earned Income: Be sure all pay stubs are clear. Employee's name, employer/source name, dates of pay period, and gross amount of pay (including tips if applicable) must all be legible. 

• Pay Stubs: Provide number of pay stubs dependant on how often recieved.  
  • Weekly - 5 pay stubs
  • Bi-Weekly - 3 pay stubs
  • Monthly - 2 pay stubs
• Self-employed individuals must provide the previous year's state income tax forms, including profit and loss statement as proof of income. 

Unearned Income: (No Bank Statments)

• SSI, Social Security, RSDI, SSDI :  Must provide 2022 benefit award letter.
• Quarterly SSI Supplemental verification
• Pension Letter/statement.
• Veteran Benefits Awards Letter
• Child Support: Must provide MICase print off showing past 90 days of income.
• Unemployment: Must provide current UIA print off or UIA Award Letter.
• Cash Assistance: Provide DHHS Case Action Letter showing past 90 days.
• Adoption Subsidy/Direct Care through the State: Provide copy of pay stubs for past 90 days. 
• Worker's Compensation: Provide 90 days of pay stubs.
• Alimony or Spousal Support: Provide Divorce agreement or MICASE statement.
• Adoption Subsidy/Direct Care letters.
• Interest, Annuities, or Dividends.
• Rental Income : Provide statements and reciept. 
• Other Income: Cash from employment, cash from friends or family, ect. (A written statement including employer/family member name, address, and phone number must be provided)

Include With Every Application:

• Valid Driver’s License or State issued ID or School ID or US Military Card or US Passport
• Social Security Card for applicant and/or name on bill
• DHHS decision letter
• Signature Statement
• COVID Statement

Include If Needing Help With Utility/Propane Assistance:

• Utility shut-off notice

Include If Needing Help With Rental Assistance, Evictions, Deposit:

• Lease
• Eviction Judgment
• Proof of Voucher
• Proof of apartment approval

Include If Needing Help With Repair Assistance

• Estimates from 3 different companies

If there are any missing required documents, the application will be halted until all information is received. This will delay the emergency assistance decision.

In accordance with federal and state laws, EightCAP, Inc. shall provide equal opportunity to its services and programs without regard for age, color, disability, familial status, experience, gender, gender identification or expression, formal education, hanidcap, height, marital or parental status, military service, national origin including limited English Proficiency, political affiliation, race, religion/creed, sex, sexual orientation, or weight. 

CAA, its agent, partners and funding sources do not discriminate on the basis of race, color, sex, religion, nationality, disability, or marital status. If you, the applicant, feel you were treated unfairly or denied service(s), please notify the agency in your county of residence to appeal and request a fair hearing. Your application will be properly reviewed to determine eligibility based on the required documentation provided.

UNDER PENALITES OF PERJURY, I SWEAR OR AFFIRM THAT THIS APPLICATION HAS BEEN EXAMINED BY, OR READ TO ME. IF I AM A THIRD PARTY APPLYING ON BEHALF OF ANOTHER PERSON, I SWEAR THIS APPLICATION HAS BEEN EXAMINED BY, OR READ TO THE APPLICANT AND TO THE BEST OF MY KNOWLEDGE THE FACTS ARE TRUE AND COMPLETE.