SUMMER CRISIS PROGRAM

JULY 1, 2011 THRU AUGUST 31, 2011

CLINTON COUNTY COMMUNITY ACTION

789 N NELSON

WILMINGTON, OH  45177

937 382-1234

HOUSEHOLDS MAY BE ABLE TO RECEIVE 1 PAYMENT ON THE ELECTRIC BILL. (NO DISCONNECTION NOTICE NEEDED)

Households who have a member 60 and older (no physician documentation required)

Or

Households  UNDER 60 who have a member who has an illness that would benefit from assistance (documentation from physician needed)

ALL households must have household incomes at or below 200% of the 2011 federal poverty guidelines

HOUSEHOLD SIZE           3 MOS               YEARLY

1                                              5,445                 21,780

2                                              7,355                 29,420

3                                              9,265                 37,060

4                                            11,175                 44,700

5                                            13,085                52,340

6                                            14,995                 59,980

FOR HOUSEHOLDS WITH MORE THAN SIX MEMBERS ADD $1,910 FOR THREE MONTHS $7,640 FOR 12 MOS.

THE FOLLOWING INFORMATION IS NEEDED:

Proof of household income for the past 13 wks or 12mos

Picture identification

Social Security numbers and DOB for everyone in the household

Electric bill and Heating bill

PHYSICIAN STATEMENT FOR HOUSEHOLDS UNDER 60 MUST STATE ON LETTERHEAD OR PRESCRIPTION (DUE TO AN ILLNESS THIS CLIENT WOULD BENEFIT FROM CONTINUED ELECTRIC SERVICE.)