Life Services Registration Form

Pay attention to the document checklist below.

CCDN Life Services Resource and Financial Assistance Program Changes for 2023

Client File and Document Checklist

1. Valid Identification – State Non-Driver's ID, Military, Continuum, Prison I.D., or State Driver’s License.
2. Proof of Residence - Current Utility Bill and Lease. (If you have an automatic lease a letter from your landlord/rental company is needed to verify a current lease)
3. Proof of Income - Retirement Statement, VA Statement, Check Stub, Unemployment, SNAP Letter (Food Stamp), Child support, TANF, and Social Security/SSI benefits Social Security for all parties receiving.
4. Other Required Information:  if indicated married or have a roommate that is on the lease. Identification and proof of income will need to be submitted for them as well. 
5. Household Member Verification: Name(s), Age(s), Gender(s), and Relationship are required for all applications

If clients are homeless:

1. Proof of Residence-
   1. Address to a homeless shelter or transitional housing facility they are in and
   2. Letter from the transitional housing facility that verifies you are a resident there
   3. If you are living in an abandoned property we will need the address to where they are dwelling
2. Valid Identification – State Non-Driver's ID, Military, Continuum, Prison I.D., or State Driver’s License.
3. Proof of Income - Retirement Statement, VA Statement, Check Stub, Unemployment, SNAP Letter (Food Stamp), Child support, TANF, and Social Security/SSI benefits Social Security for all parties receiving.
4. Household Member Verification: Name(s), Age(s), Gender(s), and Relationship are required for all applications

Important Changes to our Programs

1. SNAP Benefit Letters: No snapshots of virtual program acceptance will be taken. We will need a copy of the actual letter from The Department of Human Resources.
2. We reserve the right to decline any application.  Submitting fraudulent information can result in permanent suspension from our programs. 
3. We no longer offer repeat financial assistance in the same year. Our program provides 1-time financial assistance.  You may receive resource connections for other services multiple times. 
4. Declaration of Household Income Form. All household members, 18 and over, MUST COMPLETE a Declaration of Household Income Form if no income was received for the previous month.
5. Household Member Verification. Non-parental guardians MUST PROVIDE documentation from the Court or Department of Human Resources showing current permanent or temporary custody of children living in the household.
6. Verification of Reduced Income. If you live in reduced-income housing which includes, Public Housing, Section 8, or ANY income-based housing you must bring your lease and housing choice voucher.
7. Lease, Mortgage Statement, Utility Bills in other names: You will be required to submit additional documentation if the lease, mortgage statement, and/or utility bills are in another person's name.  Please NOTE: CCDN reserves the right to decline applications.  If fraudulent information is submitted this warrants suspension from CCDN programs. 

We no longer accept documents for this application via text message.  

To submit your documents you can upload them into this application, scan them, email them to ccdninfo2020@gmail.com, or fax them to (205) 449-5353‬.  

Please note financial assistance referral requests for rent and utility assistance the most recent bills and the current lease are needed.  If you do not submit the required documents this will prolong your application.

If you are homeless:

1. Proof of Residence-
   1. Address to a homeless shelter or transitional housing facility they are in and
   2. Letter from the transitional housing facility that verifies you are a resident there
   3. If you are living in an abandoned property we will need the address to where they are dwelling
2. Valid Identification – State Non-Driver's ID, Military, Continuum, Prison I.D., or State Driver’s License.
3. Proof of Income - Retirement Statement, VA Statement, Check Stub, Unemployment, SNAP Letter (Food Stamp), Child support, TANF, and Social Security/SSI benefits Social Security for all parties receiving.
4. Household Member Verification: Name(s), Age(s), Gender(s), and Relationship are required for all applications

Declaration of Household Income

Instructions: This section is to be completed by the person applying for assistance if any of the following situations
apply to the applicant and/or any household member age 18 and over for the previous month:

1. Had no income and verification cannot be obtained from a government entity such as the Department of
   Human Resources, Department of Labor, Public Housing manager, etc.
2. Received income from occasional work such as lawn care, house cleaning, babysitting, car repair, etc. when
   a receipt book is not maintained.
3. Received money from family/friends
4. Received income not reported elsewhere.

Disclaimers: Please read the following statement carefully. Then sign the form and write in today’s date.

I certify that my yearly gross household income is at or below the income listed on this form for households with the same number of people as my household, OR that my household participates in the program that I have checked on this form.  I also certify that, as of today, my household lives in the area served by the ALABAMA EMERGENCY FOOD ASSISTANCE PROGRAM.  This certification form is being completed in connection with the receipt of federal assistance.  Program officials may verify what I have certified to be true. I understand that making a false certification may result in having to pay the state for the value of the food improperly issued to me and may subject me to criminal prosecution under state and federal law.

If you need to register for emergency food please click the link to the closest pick-up location you are interested in picking up from.  Please pay attention to location pick-up days and times when you register.  Be sure to open the link in a new tab or select the food hub from our website www.ccommunitycaredn.org.