Low Income Templates

This document is for residents of Pennsylvania who wish to apply for Pace/Pacenet benefits. These benefits help eligible individuals afford prescription medication.

This document is for applying for financial assistance in New Hampshire.

This document is an application for the low-income discount on the annual street maintenance fee in Corpus Christi, Texas. It is for residents who qualify for a reduced fee based on their income.

This Form is used for applying for the Ryan White Care program in the state of New Hampshire. The program provides HIV/AIDS-related medical care and support services to eligible individuals.

This document is a vendor agreement for electric or natural gas services under the Low-Income Home Energy Assistance Program (LIHEAP) in Iowa. It outlines the terms and conditions for providing energy assistance to low-income households.

This form is used for renewing your Medi-Cal benefits in California. It is available in the Lao language.

This document describes the snap changes made to existing group homes in the state of Maine.

This form is used for applying for the Low Income Home Energy Assistance Program (Liheap) in North Carolina.

This document is a worksheet used in California to calculate the Duplication of Benefits (DOB) for ESG-CV funding. It helps determine if an applicant is receiving duplicate assistance from other sources.

This document is for senior citizens in New York City who want to apply for a rent increase exemption through the Senior Citizen Rent Increase Exemption (SCRIE) program.

This document is essential for residents of Massachusetts who primarily speak Portuguese and need to prove their financial hardship situation legally, often in scenarios like obtaining legal aid or waiving court fees.

This Form is used for declaring low-income earned income exclusion and electing not to withhold state income tax in West Virginia.

This form is used for nonprofit housing development organizations in Maine that are seeking an exemption for developing housing for low-income individuals.

This form is used for exempting low-income tribal housing in Riverside County, California.

This Form is used for notifying vacancies in project-based units in New York City.

This document is used for individuals in the City of Toledo, Ohio, who are claiming to be indigent and unable to afford legal fees. It allows them to request a waiver of court costs and fees based on their financial circumstances.

This document is a Poverty Affidavit used by the City of South Euclid, Ohio to determine financial need for certain assistance programs.

This form is used for requesting a referral to the Kentucky WIC program, which provides food assistance for low-income women, infants, and children.

This document is a pre-application form for the Rural Workforce Housing Initiative Equity Fund in Georgia. It is used to assess eligibility and gather information from individuals or organizations seeking housing assistance in rural areas of Georgia.