PROJECT REACH - ENERGY ASSISTANCE PROGRAM APPLICATION

Transcripción

1 PROJECT REACH - ENERGY ASSISTANCE PROGRAM APPLICATION Please fax the completed form along with the approved client list to United Way at (702) , Attn: John Miller. Remember to include a copy of your applicant s NV driver license or NV State ID and the utility bill in need of payment. Name: Social Security Number: NV Driver License or NV State ID: Phone: Date of Birth: Address: City: State: Zip Monthly Expenses: Mortgage/Rent: Other: Medical: Pharmacy: Amount Requested: Amount $ Bill Attached: Total # of Persons in Home: Name(s) and age(s) of relative(s) residing with you: Including self, is anyone in household: ( ) age 62 or over ( )medically fragile* ( ) other: *Requires acceptance into the Nevada Power GreenCross program. GreenCross application required: Type of Dwelling: (check only one) H=House ( ) M=Mobile Home( ) S=Studio( ) A=Apartment ( ) O=Other ( ) Would you be interested in weatherization or conservation information Own or Rent (circle) Yes No List Income: Social Security: Retirement: Employment: Other: This box to be used to document special circumstances: I certify that the applicant qualifies for assistance based on income guidelines, household and medical expenses and/or documented need. The applicant has been informed that this assistance is available one time in a 12-month period. Applicant Signature: Agency Representative: Title: Date: Phone: Organization: Exhibit I-2 Senior Citizens and Veterans Document consists of 5 pages. Entire Exhibit Provided. Meeting Date:

2 Project REACH Program Criteria & Guidelines Project REACH is an annual energy assistance program designed to help Nevada Power customers who, through uncontrollable or unplanned hardships, are unable to pay for their energy needs. The program is funded by Nevada Power and administered through United Way of Southern Nevada. Energy Emergency Defined as: "An uncontrollable or unplanned change in their ability to pay for their energy needs." The maximum amount an applicant can receive for assistance is $500. The utility bill must be at least 14 days past due for funds to be issued. Applicants are responsible for deposits, returned check fees and charges, meter damage charges, fraudulent usage fees, and final bills. Eligibility The applicant is eligible if they are a senior citizen (age 62 and over), are disabled or have a medical condition deemed life threatening (as determined by a licensed doctor), Reserve or National Guard member. The maximum annual gross income of the household during the year must be within Project REACH guidelines. Applicants may apply for Project REACH assistance only once during a twelve 12-month period. Project REACH assistance is for residential customers only. It does not provide assistance for business or commercial customers. Project REACH assistance cannot be used to restore service if it has been terminated due to nonpayment or because of a default in payment arrangements. The Nevada Power bill must be in the applicant s name and the applicant must reside at the address for which assistance is needed. Funds will not be issued where the account is in the name of the property landlord or in the name of a minor child. Explanation must be provided if the bill is in the name of someone other than the applicant. Application Process Applicant must complete an application and provide a copy of their Nevada Power bill when requesting Project REACH assistance. If the applicant is medically fragile, the partner agency must ask the United Way Program Manager to arrange for registration in Nevada Power s GreenCross program. Customers must apply directly at one of the United Way partner agencies to receive assistance. The United Way partner agency, along with a designated Nevada Power representative, will determine how much, if any, assistance will be administered to the applicant. Applicants are responsible for payment of any amount that exceeds the Project REACH award. If an applicant receives assistance and has an unpaid balance remaining, they must contact Nevada Power immediately at to make payment arrangements. Before Project REACH assistance can be applied to their account, the applicant must bring in a receipt as proof of payment toward their unpaid balance. Financial assistance is paid directly to Nevada Power for credit to the applicant s account. 10-Day or 48 Hour Notice The United Way partner agency will immediately notify Nevada Power of the award being made in order to avoid termination of service (particularly in cases where the applicants have received a 48-hour notice). Project REACH cannot pay on closed accounts or transferred accounts. Good Payment History Consideration will be given first to applicants with an "emergency" need for assistance. A reoccurring poor payment history (such as multiple termination of service notices and service disconnections) suggests that the payment problems may continue whether or not Project REACH funds are granted. 2

3 Verification of Income Applicant must provide verifiable proof of income or pending income. "Cash Only" applicants must provide one of the following: Letter from the employer on company letterhead. Current bank statement showing recent deposit activity. Current income tax records. Monthly food stamps allotment cannot be included as part of household income. Student loans cannot be included as part of household income. Reserve and National Guard Members Application must meet current Project REACH income guidelines. Application must show Reserve or National Guard identification. Applicant must show activation papers. The maximum annual gross income must not exceed the following: Household Size Maximum Annual Gross Income 1-2 $ 29,300 3 $ 34,400 4 $ 41,500 5 $ 48,600 6 $ 55,700 Each additional $ 7,100 In addition to the application and information on income, applicants may be asked: Are there any unusual circumstances that require you to seek energy assistance? Please provide proof of circumstances. After receiving energy assistance from this program, will you be able to keep current with future bills? Do you live in any form of subsidized housing? Do you have a deferred payment agreement (DPA) with Nevada Power Company? Within the last 12 months, have you applied for or received assistance from any state and/or federal lowincome energy assistance programs? Please Note: Due to the large number of applications received, it may take up to 15 working days to process this application. INCOMPLETE OR FRAUDULENT INFORMATION WILL ELIMINATE THIS APPLICATION FROM CONSIDERATION 3

4 customer service Energy Assistance and Customer Support Programs Help for those in need Financial Assistance Nevada Energy Connection (866) nevadaenergyconnection.nv.gov Payments are made directly to the energy company on the customer s behalf. Household Size Maximum Annual Income 1...$ 15, $ 20, $ 25, $ 30, $ 36, $ 41, $ 46, $ 51,855 Each Additional...$ 5,220 Valid through June 30, 2008 Project REACH (702) A Nevada Power funded program for customers 62 years and older, medically fragile or Reserve and National Guard members who meet the income guidelines below. Qualified customers may apply at United Way partner agencies. Funds are available year round until exhausted. Household Size Maximum Annual Income $ 29, $ 34, $ 41, $ 48, $ 55,700 Each Additional...$ 7,100 Valid through June 30, 2008 Weatherization Assistance In Clark County (except the City of Henderson) HELP of Southern Nevada: (702) helpsonv.org For the City of Henderson Neighborhood Services: (702) cityofhenderson.com/index.php Comfort Savings (866) Typical weatherization assistance measures may include but are not limited to: Ceiling, floor and duct insulation Duct leakage sealing (return and supply systems) Shell infiltration sealing (replace broken windows, replace exterior doors and windows, weather stripping, caulking, evaporative cooler covers, etc.) Insulation of water heater and water heater pipes Solar screens Heating and cooling system repairs/ replacements Compact fluorescent lamps (CFLs) Assistance for the hearing impaired You can communicate directly with our Customer Service department by phone if you have teletype transmitting equipment (TDD/ TTY). Call (702) , Monday through Friday 8 a.m. to 5 p.m. Third Party Notification To help prevent disconnects due to misplaced or forgotten electric bills, Nevada Power offers a third-party notification service. We notify the party you indicate (a friend, relative or agency) when your electric service may be in jeopardy because of an unpaid bill. The third party is under no obligation to pay the bill but can provide you with a friendly reminder to help you avoid any inconvenience. Please call our 24-hour Customer Service department at if you are interested in this service. Senior and Disabled Customers We at Nevada Power are concerned about our elderly and vulnerable customers. If there is a permanent resident living in your home who is seriously ill, disabled or 62 years of age or older, please call us so we can update your account information. Green Cross (Life Support Equipment) Are you or permanent members of your household dependent on electrically operated medical equipment in use 24-hours a day? If yes, then call and a customer service representative will send you an enrollment packet for you to complete and return to sign up for the Green Cross program. Gatekeeper Program Nevada Power s employees, such as meter readers, field service representatives and customer service representatives, are trained to recognize when residents may need assistance. We inform the appropriate agencies who can investigate and provide any assistance necessary. Equal Payment Plan With this payment option, we ll take your average power usage and divide it into equal payments so you ll know in advance what your bill will be each month. Electric Check You never have to worry about paying your bill on time with this convenient service. With Electric Check, you can pay your power bill with an automatic withdrawal directly from your checking or savings account on the day the bill is due. Payment Arrangements If you have difficulty making a payment, please call us as we may be able to make payment arrangements with you depending upon a number of factors including your past credit history. npc/lvcg 3500 rev.07/07

5 servicio al cliente Programas de Ayuda con Costos de Energía y Apoyo al Cliente Ayuda para aquellos que la necesitan Asistencia financiera Nevada Energy Connection (866) nevadaenergyconnection.nv.gov Los pagos se hacen directamente a la compañía de energía de parte del cliente. Miembros de Familia Ingreso Máximo Anual 1...$ 15,315 dólares 2...$ 20,535 dólares 3...$ 25,755 dólares 4...$ 30, 975 dólares 5...$ 36,195 dólares 6...$ 41,415 dólares 7...$ 46,635 dólares 8...$ 51,855 dólares Por miembros adicionales...$ 5,220 dólares Válido hasta el 30 de junio de 2008 Proyecto REACH (702) Un programa subsidiado por Nevada Power para clientes de 62 años y mayores, personas frágiles de salud o miembros de la Reserva y Guardia Militar que cumplen con los lineamientos de ingreso que se muestran a continuación. Los clientes calificados pueden llenar una solicitud en las agencias asociadas de United Way. Los fondos están disponibles todo el año hasta agotarse. Miembros de Familia Ingreso Máximo Anual $ 29,300 dólares 3...$ 34,400 dólares 4...$ 41,500 dólares 5...$ 48,600 dólares 6...$ 55,700 dólares Por miembros adicionales...$ 7,100 dólares Válido hasta el 30 de junio de 2008 Programa de asistencia para climatización En el Condado de Clark (excepto en la Ciudad de Henderson) HELP of Southern Nevada: (702) helpsonv.org Para la Ciudad de Henderson Servicios Vecinales: (702) cityofhenderson.com/index.php Asistencia para ahorrar energía (866) Las medidas típicas de climatización que se instalan por medio del programa de ahorros Comfort Savings pueden incluir, pero no están limitadas a: Instalación de aislante en el techo, los pisos y los conductos Sellado de las fugas de los conductos (sistemas de provisión y retorno) Sellado de las infiltraciones de los revestimientos (reemplazar ventanas rotas, reemplazar puertas y ventanas exteriores, sellos de las puertas, sellado de climatización, cubiertas de enfriadores por evaporación, etc.) Instalación de aislante en los calentadores de agua y sus tuberías Pantallas solares Reparaciones / cambios de los sistemas de refrigeración y calefacción Bombillas fluorescentes compactas (CFL s, por sus siglas en inglés) Asistencia para Personas con Problemas Auditivos Usted puede comunicarse directamente con nuestro departamento de Servicio al Cliente por teléfono si cuenta con un equipo de transmisión de teletipo (TDD/TTY, por sus siglas en inglés). Llame al (702) de lunes a viernes de las 8 a.m. a las 5 p.m. Notificación a Terceras Partes Para ayudar a prevenir que su servicio sea desconectado debido a recibos de electricidad olvidados o perdidos, Nevada Power ofrece un servicio de notificación a terceras partes. Nosotros notificamos a quien usted nos indique (un amigo, familiar o agencia) cuando su servicio de electricidad puede estar en peligro de desconexión debido a la falta de pago de su recibo. La tercera parte no está bajo ninguna obligación de pagar el recibo, pero puede proveerle un recordatorio para ayudarle a evitar inconveniencias. Por favor llame a nuestro departamento de Servicio al Cliente las 24 horas al teléfono si usted está interesado en este servicio. Clientes con Discapacidades y Personas Mayores En Nevada Power estamos preocupados por nuestros clientes mayores y vulnerables. Si hay un residente permanente viviendo en su hogar que tiene una enfermedad seria, discapacidad o tiene 62 años o más, por favor llámenos para que podamos actualizar la información de su cuenta. Máquina de Corazón-Pulmón Depende usted o algún miembro de su hogar de equipo médico eléctrico las 24 horas del día? Si su respuesta es sí, entonces llame al y un representante de servicio al cliente le enviará un paquete de inscripción para que usted lo complete y nos lo envíe para inscribirlo en el programa Green Cross. Programa Gatekeeper Los empleados de Nevada Power, como quienes miden los medidores, representantes de servicio de campo y representantes de servicio al cliente, están capacitados para reconocer cuando los residentes pueden necesitar asistencia. Nosotros informamos a las agencias correspondientes que pueden investigar y brindar la ayuda necesaria. Programa Equal Payment o Pagos Iguales Con esta opción de pago, nosotros tomamos el uso promedio de electricidad y lo dividimos en pagos iguales para que usted sepa por adelantado la cantidad a pagar en su recibo cada mes. Electric Check o Cheque Electrónico Nunca tiene que preocuparse por pagar su recibo a tiempo con este conveniente servicio. Con el programa Cheque Electrónico usted puede pagar su recibo de electricidad con una deducción automática directamente de su cuenta de cheques o cuenta de ahorros el día en el que se vence el recibo. Arreglos de Pago Si tiene dificultades para realizar un pago, por favor llámenos, quizá podríamos acordar arreglos de pago con usted dependiendo de un número de factores, incluyendo su historial crediticio.