Bear River Association of Governments

Human Services Applicant,

 

You may complete the following application to submit it online. You may also pick up a paper copy at the BRAG office located at 170 North Main, Logan UT 84321.

Our funds are very limited; there is no guarantee that you will receive assistance. Applications will be active for 30 days. 

Any application that is not completed in its entirety will be automatically denied. Please ensure that every houshold member over the age of 18 signs every page, and that all the applicable questions are answered.

This application is intended for individuals who are: at risk of being evicted, or are already homelessness, i.e. living in a place not meant for human habitation, in a hotel paid for by an organization, in an emergency shelter, or in transitional housing. Household qualification is based on the 2026 National Poverty Guidelines as well as the 2026 Area Median Income. Every person in your household/on your rental agreement mist be included in your Intake packet and every person age 18 and older must sign.

Households who are experiencing literal homelessness will be evaluated on a number of different vulnerability factors to identify the type of support and housing intervention needed for their stability. It is important for you to keep your contact information updated. If we are unable to contact you, you will be taken off the list and will have to reapply.

START primarily communicates through email. You must provide a valid email address if you wish to pursue our services. Please ensure that your mailbox is able to accept new emails. 

The following documents are required for us to process your application: 

◻ Social Security Cards/Permanent Resident Cards – all household members
◻ Picture ID – all household members over 18 years of age
◻ Birth Certificate – all household members
◻ Proof of Income – For the last 30-days
◻ DWS Benefits Report: printout available through My Case (if applicable)
◻ Documentation supporting crisis – ex: Eviction Notice/Tenant Ledger
◻ Fully executed signed lease agreement/contract (if applicable)

 

BRAG uses the following poverty guidelines to determine eligibility for our programs. The amounts listed above are based on gross monthly income.

According to Community Action Program Legal Services (CAPLAW), the income of all members of each individual family unit must be included in determining the income eligibility.

Each funding source utilizes different percentages of poverty to qualify households income. All eligible funds will be looked at to assist applicants.

 

 

 

Household/Family Size	50%	75%	100%	125%	133%	135%	138%	150%	175%	180%	185%	200%
1	$665	$998	$1,330	$1,663	$1,769	$1,796	$1,836	$1,995	$2,238	$2,394	$2,461	$2,660
2	$902	$1,353	$1,803	$2,254	$2,398	$2,435	$2,489	$2,705	$3,156	$3,246	$3,336	$3,607
3	$1,138	$1,708	$2,277	$2,846	$3,028	$3,074	$3,142	$3,415	$3,984	$4,098	$4,212	$4,553
4	$1,375	$2,063	$2,750	$3,438	$3,658	$3,658	$3,795	$4,125	$4,813	$4,950	$5,088	$5,500
5	$1,611	$2,418	$3,223	$4,029	$4,287	$4,352	$4,448	$4,835	$5,641	$5,802	$5,963	$6,447

We are currently 2 weeks behind on processing our applications for short term rental assistance. You are still responsible for paying your rent. We advise you to seek an alternative method of paying it. 

Please provide us with identifying documents with your application (social security cards, photo ID’s, lease agreements), and we will reach out to you for proof of income once we begin processing your application.

If you do not currently work or reside in either Cache, Rich, or Box Elder Counties, and you have not been approved for housing in any of these areas, you do not qualify for our services. Please do not apply. 

Please see the Community Action Partnership of Utah's website to determine which network provider you should apply with. 

Please note, In order to maintain a safe and productive environment, the following behaviors will not be tolerated:

a. Verbal Abuse including use of profanity or aggressive words, making threats, and being disrespectful toward BRAG staff or clients.

b. Physical Abuse including inflicting harm or intent to harm

c. Emotional Abuse including name calling and belittling.

d. Sexual abuse including elicitation or solicitation of a sexual nature or making sexual overtures/induendos.

e. Possession of illegal substances and/or drug paraphernalia, presenting uder the influence and/or in an altered state.

f. Possession of handgun or other lethal weapon

g. Behaviors that promote a negative atmosphere including unnecessary or excessive phone calls, emails and other forms of negative communication.

 

If someone engages in behavior that endangers the safety or wellbeing of others, staff may take immediate steps to protect the safety of individuals and the office, including asking the client to leave the premises, contacting law enforcement, or terminating services.

BRAG does not discriminate based on race, color, national origin, sex, age, disability, or income status. Our Title VI policy can be can be found on our website at:

BRAG Discrimination Policy

All household members over the age of 18 must sign. By signing below, I verify that the information I have provided is true and accurate to my knowledge. I understand that providing misleading or false information will result in denial or termination of assistance.

All household members over the age of 18 must sign. By signing below, I verify that the information I have provided is true and accurate to my knowledge. I understand that providing misleading or false information will result in denial or termination of assistance.

Please submit the following documents with your application:
◻ Social Security Cards/Permanent Resident Cards – all household members
◻ Picture ID – all household members over 18 years of age
◻ Birth Certificate – all household members
◻ Proof of Income – For the last 30-days
◻ DWS Benefits Report: printout available through My Case (if applicable)
◻ Documentation supporting crisis – ex: Eviction Notice/Tenant Ledger
◻ Fully executed signed lease agreement/contract (if applicable)

Consent for Coordinated Services & Release of Information

I hereby authorize Bear River Association of Governments (BRAG) to share information regarding services my household and I have received or will receive with organizations relevant to my case. This may include but is not limited to the following organizations: utility companies, my landlord, Bear River Mental Health, Citizens Against Physical & Sexual Abuse (CAPSA), William A Burnard (WAB) Warming Center, Utah Families Feeding Families, New Hope Crisis Center, Division of Child and Family Services (DCFS), and Department of Workforce Services (DWS). I understand that the information will remain confidential and is protected by state and federal law, and will only be used for my benefit or to benefit other members of my household.

Information to be Released: All information concerning my care. Non-identifying information may also bc used for the purposes of research to ensure program success and current and potential funding sources.

Purpose of Release: The purpose of sharing this information is to improve the coordination of services to better promote housing stability.

l) To provide coordinated housing, medical, social, psychological, and other services

2)  To evaluate outcomes related to service delivery

3)  To improve coordination of services to assist in becoming stably housed and self-supported

Not Required for Services: I understand that authorization is voluntary and that I may refuse to sign this authorization. I also understand that refusal to share information with certain organizations may prevent me from receiving specific services from certain programs.

Right to Revoke: I understand that my consent will last one year from today's date unless I revoke my authorization in writing before that time.

Utah Homeless Management Information System:

Informed Consent Release Form

What is UHMIS?

(Agency)                   participates in the Utah Homeless Management Information System (UHMIS)r an online database that collects information about persons in Utah who are experiencing honlelessness, those at risk of homelessness, and those who are formerly homeless,

What type of information is asked of me?

UHMIS asks for identifying information including, but not limited tot basic demographics (i.e., Namer Date of Birthr etc), limited health data (i.e., disabling condition), and financial information, Each question has been carefully reviewed to ensure only the minimum required information necessary is collected.

Who is it shared with?

 must collect client information in UHMIS for program participationr even if you choose not to sign this form. However, information is shared with other providers only after you sign this consent form to release that information. For more information on how your information is protected and shared, please scan the QR code on this page or go to UtahH(v11S.01g/ForÆltents.

What happens if I choose not to sign this form?

• You may refuse and will not be denied services unless a specific funding source for those services requires client information to be shared in UHMIS,
• You may refuse to share your information with only one or all other providers-
• You may choose not to share any specific data element even after signing this consent form,
• For IAeenvt') to serve you with this UHMIS participating project, your information will still be entered into UHMIS and be visible to the users who work for this agency. It will also be visible to a small group of people not employed with this agency who provide security, oversight, data analysisr and research to improve services for those served by UHM15

When does your consent end?

By default, your consent will end seven years after the signature date; however, you may also change your consent to share at any time. Due to the nature of UHMIS, when your consent ends, this agency will share no new information, but this agency will not remove anything already shared within the system.

Your Rights

•   You may request this document in a format better suited to your needs and understanding.
•  You may request to see information for yourself and your legal dependents and to change it if it is incorrect.

 

I understand the above statements and consent to including personally identifying information in UHMIS about me and any dependents listed below. I authorize the information collected to be shared with other providers. I understand that my personal identifying information will not be made public and wa ill only be used with strict confidentiality, I also know that I may withdraw my consent at any time by submitting a UHMIS Informed Consent Revocation Form, which can be provided to me by this agency. I understand I may obtain a copy of my signed consent form from this Agency.

Grievance Procedure

This Grievance Procedure is to be followed by program consumers who are dissatisfied with or are denied services under programs funded by Community Service Block Grant (CSBG), Social Service Block Grant (SSBG), and any other grant or program overseen by the Bear River Human Services Council. Attempts will be made to resolve grievances as quickly as possible.

Informal: Consumer will bring the issue to attention of the local program provider. If not resolved to consumer's satisfaction, the consumer has the option of pursuing the grievance by issuing a formal complaint.

1. Formal Complaint
   Consumers will submit written grievances to local program providers within five (5) working days of the incident or of knowledge of the incident. The local Program Provider will respond in writing within ten (10) working days. If not resolved to the consumer's satisfaction, they have the option to proceed.
2. If the issue is still not resolved to consumer's satisfaction, consumers may submit a written grievance within ten (1()) working days to the Director of Community Action, Bear River Association of Governments, 170 North Main Street, Logan, Utah 84321. The Director of Community Action will respond in writing within ten (10) working days. If not resolved to consumer's satisfaction they have the option to proceed.
3. If the issue is still not resolved to consumer's satisfaction, consumers may submit a written grievance within ten (10) working days to the Executive Director of Bear River Association of Governments, 1 70 North Main Street, Logan, Utah 84321. The Executive Director will utilize support staff or Human Services Council support as deemed necessary to investigate information and render a decision regarding the grievance. The Executive Director will respond in writing within ten (10) working days. If not resolved to the consumer's satisfaction, they have the option to proceed.
4. If the issue is still not resolved to consumer's satisfaction, consumers will be provided with address and telephone number(s) for the Chairperson of both the Bear River Human Sewices Council and Bear River Association of Governments Steering Committee. A hearing before the Human Services Council will offer the next level of grievance and help remedy appropriate action(s) regarding the complaint. The nature of the complaint and the investigation shall be properly documented. The response to the consumer will address the complaint received and relevant action taken. If any member of the Human Services Council has involvement in the grievance, those members shall exclude themselves from the grievance procedure.
5. If the decision is not to the satisfaction of the consumer, the consumer shall be referred to the appropriate state agency's grievance procedure. In most instances, this will be the Utah Department of Workforce Services or the Utah Department of Human Services.

I understand the BRAG Grievance Procedures Policy and if I have a complaint related to the completion of services that I have received from BRAG, I have the right to file an appeal. This appeal must be made within five (5) days from the incident or knowledge of the incident.

Please make appeal to Stephanie Carver, START Director, stephaniec@brag.utah.gov or Lucas Martin, BRAG Executive Director, lucasm@brag.utah.gov

Watch Out for Lead-Based Paint Poisoning!

If a home was built before 1978, it may contain lead-based paint. About three out of every four pre-1978 buildings have lead-based paint.

What is Lead Poisoning?

Lead poisoning means having a high concentration of lead in the body.

Lead can:

• Cause major health problems especially in children under 6 years old,
• Damage a child's brain, nervous system, kidneys, hearing, or coordination.
• Affect learning.
• Cause behavior problems, blindness, and even death
• Cause problems in pregnancy and affect a baby's normal development.

Who Gets Lead Poisoning?

Anyone can get it, but children under 6 are at the greatest risk, because their bodies are not fully grown and are easily damaged. Women of childbearing age are also at risk, because lead poisoning can cause miscarriages, premature births, and the poison can be passed on to their unborn babies.

Where Does it Come From?

The lead hazards that children most often touch are lead dust, leaded soil, loose chips, and chewable surfaces with lead based paint. A child may be harmed when it puts into its month toys, pacifiers, or hands that have leaded soil or lead dust on them. Lead also comes from:

• Moving parts of windows and doors that can make lead dust or chips. e Lead-based paint on surfaces in the home.
• Drinking water (pipes and solder),
• Parents who bring lead dust home from work on skin, clothes, and hair.

How do I Know if My Child is Affected?

Is your child:

• Cranky?
• Unable to concentrate?
• Vomiting?
• Hyperactive?
• Tired?
• Complaining of stomach aches or headaches?
• Unwilling to eat or play?

These can be signs of lead poisoning. However, your children might be poisoned and not show any signs. Only your clinic or doctor can test to be sure.

What Can I Do About it?

If you suspect your child has been exposed to lead, make an appointment with your doctor or clinic. If you think your unit might have sources of lead poisoning, call the Bear River Health Department.

Acknowledgment

I acknowledge that I have received and read a copy of this notice.