r h n ademark rig o ome n edof assista c , i t a need a helping hand? public assistance programs c...
TRANSCRIPT
Acc
ount
Num
ber
Cust
omer
Num
ber
1.
I cur
rent
ly p
artic
ipat
e in
the
follo
win
g pr
ogra
m(s
):
Sou
ther
n Ca
lifor
nia
Edis
on (C
.A.R
.E.)
S
outh
ern
Calif
orni
a G
as C
ompa
ny (C
.A.R
.E.)
S
SI
Med
i-Cal
/Med
icai
d
WIC
N
atio
nal S
choo
l Lun
ch (N
SLP)
Cal
Fres
h/SN
AP
H
ealth
y Fa
mili
es A
&B
B
urea
u of
Indi
an A
airs
Gen
eral
Ass
ista
nce
T
AN
F/Tr
ibal
TA
NF
L
IHEA
P H
ead
Star
t Inc
ome
Elig
ible
(Trib
al O
nly)
2.
Chec
k th
e to
tal n
umbe
r of p
erso
ns in
you
r hou
seho
ld.
One
(1)
Tw
o (2
) T
hree
(3)
Fou
r (4)
F
ive
(5)
Six
(6)
M
ore
than
Six
(6+)
,
N
umbe
r
Adu
lts
Child
ren
Tota
l Num
ber
3.
Writ
e th
e to
tal y
early
hou
seho
ld in
com
e fo
r all
pers
ons
in y
our h
ouse
hold
.
This
is in
com
e be
fore
ded
uctio
ns fr
om a
ll so
urce
s:
4.
Chec
k al
l sou
rces
of i
ncom
e fo
r you
r hou
seho
ld:
Wag
es
or S
alar
ies
D
isab
ility
Pay
men
ts
Cal
WO
RKs
(TA
NF/
AFD
C)
In
tere
st o
r Div
iden
ds fr
om:
R
enta
l or R
oyal
ty In
com
e
Wor
kers
Com
pens
atio
n
Cal
Fres
h/SN
AP
Sav
ings
Acc
ount
S
chol
arsh
ips,
Gra
nts,
or o
ther
S
ocia
l Sec
urity
, SSI
, SSP
C
hild
Sup
port
S
tock
s or
Bon
ds
Aid
Use
d fo
r Liv
ing
Expe
nses
P
ensi
ons
Cas
h an
d/or
Oth
er In
com
e
5.
I st
ate
that
the
info
rmat
ion
I hav
e pr
ovid
ed in
this
appl
icat
ion
is tr
ue a
nd c
orre
ct. I
agre
e to
pro
vide
proo
f of i
ncom
e if
aske
d. I
agre
e to
info
rm L
iber
ty U
tiliti
es if
I no
long
er q
ualif
y to
rece
ive
the
disc
ount
. I kn
ow th
at if
I re
ceiv
e an
y di
scou
nt w
ithou
t
qual
ifyin
g fo
r it,
I may
be
requ
ired
to p
ay b
ack
the
disc
ount
that
I re
ceiv
ed. I
unde
rsta
nd th
at L
iber
ty U
tiliti
es c
an sh
are
my
info
rmat
ion
with
oth
er
ut
ilitie
s or t
heir
agen
ts to
enr
oll m
e in
thei
r ass
istan
ce p
rogr
ams.
Sign
atur
e
P
rint N
ame
D
ate
Add
ress
City
Phon
e
$
+=
©Co
pyrig
ht a
nd tr
adem
ark
right
s re
serv
ed.
Calif
orni
a Al
tern
ate
Rate
s for
Wat
er (C
ARW
) App
licat
ion
HOW TO QUALIFY
1
MAXIMUM HOUSEHOLD INCOME(Effective June 1, 2020 to May 31, 2021)
2OR
Number of Persons in Household Total Annual Income*
1-2 3 4 5 6 7 8
For each additional household member, add $8,960* Includes current household income from
all sources before deductions.
PUBLIC ASSISTANCE PROGRAMSIf you or another person in your household receives
benefits from any of the following programs:
Medi-Cal/MedicaidHealthy Families Categories A & BWomen, Infants & Children (WIC)CalWORKS (TANF) or Tribal TANF
Head Start Income Eligible––Tribal OnlyBureau of Indian Affairs General Assistance (BIA GA)
CalFresh / SNAP (Food Stamps)National School Lunch Program (NSLP)
Low Income Home Energy Assistance Program (LIHEAP)Supplemental Security Income (SSI)
Liberty Utilities P.O. Box 7002
Downey, CA 90241
For our neighbors who may be in need of assistance, Liberty Utilities is proud to offer the California Alternate Rates for Water Program (CARW).CARW is a low-income rate assistance program that provides a monthly discount of $7.70 on the water bill to qualifying residential customers.
There are two ways to qualify for CARW:
By participating in another utilities low-income assistance program (such as CARE from the Southern California Gas Company) or receiving benefits from programs such as Medicare, Medi-Cal and more.
By providing information that house- hold income meets program guidelines.
Enrolling is quick and easy. Just complete the attached application and return it to our office either in person or by mail.
1
2
Questions about CARW?Contact Customer Service at 562-923-9671 Or visit libertyutilities.com.
$34,480$43,440$52,400$61,360$70,320$79,280$88,240
(c)2016 Liberty Utilities. All rights reserved.
www.libertyutilities.com
See if Your Household Qualifies
Need a Helping Hand?The California Alternate Rates for Water Program