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Income Guidelines & Application Requirements

Eligibility is determined by the last 30 days of gross income. Monthly income cannot exceed the amount
listed below for the number of persons living in the household:
1 person 2 persons 3 persons 4 persons 5 persons 6 persons 7 persons
$2,091 $2,735 $3,379 $4,022 $4,666 $5,310 $5,430

REQUIRED DOCUMENTS: UTILITY BILL
Submit a copy of ALL PAGES of the most recent energy bill (for the last 30 days).
Utility Account: Submit copies of:

Gas & Electric (PG&E) ALL pages of most recent bill and shutoff notice if applicable.

Wood or Propane Account Recent statement or invoice and a copy of the most recent utility bill.
Sub-Metered Utilities Most recent rent receipt showing your gas and electric costs.
Letter from your landlord stating the total amount of rent that goes
Utilities Included in Rent
towards monthly energy costs or a CCES Certification Form.

REQUIRED DOCUMENTS: INCOME
Submit copies of income documents for the LAST 30 DAYS for ALL adults in the household receiving
income or aid. Adult household members with no income must submit a written statement explaining
how they support themselves in absence of income.

Income Received: Submit copies of:
Current copy of paycheck stubs covering one full month (if paid
Wages/Earned Income weekly last 4 pay stubs; if paid bi-weekly last 2 pay stubs), letter or
printout from employer with gross amount and time period.
Copy of current check, most recent bank statement showing direct
SSI/SSP/SSA deposit, dated annual benefit letter, payee letter showing income
amount, Form 4926, Form 2458, HUD statement with a SS amount.
Pensions, Annuities, Current copy of check, pension verification, annual statement, bank
Interest/Dividend Income statement showing direct deposit.
Current copy of check, Notice of Action, Passport to Services,
General Assistance/ verification from worker with amount & date, food stamp verification,
CalWorks/TANF
or aid summary, CalFresh award letter.
Workers Comp., Disability, Current copy of checks/check stub, printout, or award letter
Unemployment Benefits
Current court document, copy of check, current signed statement
Child/Spouse/Individual Support
from person providing report, notice of action showing support
Current copy of check, benefit letter, letter of verification from VA, or
Veteran's Benefits
copy of bank statement showing direct deposit
Copy of ledger/journal, signed self-employment statement showing
Self-Employment
month, gross receipts, gross expenses and net income, 1040 form
Written statement for odd jobs with dollar amounts and dates, current
Other
receipts for recycled materials.