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Community Action Agency

Utility Intake Questions


Do you rent or own your home?
If you rent, is it paid up to date?

Does this person live with you currently?

Is your bill past due?
Have you applied for utility assistance from DHHS since October 1?

Have you received utility assistance from DHHS since October 1?
Do you have a denial letter from DHHS?

Have you previously received assistance with CERA funding?

Utility Information:

Additional Notes: