Beneficiaries must document income eligibility and housing/utilities related hardship during COVID-19. The hardship and supporting documentation must be no older than March 10, 2020, which is when a national emergency for COVID-19 was declared.
Please fill out this form as completely and accurately as possible.
Please list names and date of birth for all persons living in the Household (include children under 18 years old)
Under CDBG-CV Program requirements, applicants may only receive assistance if their income meets certain thresholds. These thresholds are set by the US Department of Housing and Urban Development. Additionally, applicants must provide documentation supporting their reported income, and documentation demonstrating a COVID-19-related hardship.
Please provide copies of official documentation that validate your reported income amount. Examples could include recent pay stubs, W2s, Social Security or Disability payments, etc.
If you have lost your job due to COVID-19, please provide your last available pay stub and supporting documentation, such as a layoff notice or unemployment filing.
Please provide documentation supporting your claims of hardship. Examples may include utility disconnection notices, utility payment plans (if entered into after March 10, 2020), notices related to eviction proceedings, etc.
This information is used for eligibility/award determination and state reporting requirements. It is not a public record and will be kept confidential.
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Please read the following information carefully.
Consideration for and participation in the Asheboro COVID-19 Community Housing/Utility Assistance Program comes with conditions and responsibilities. To benefit from this program:
You must meet program income requirements at the time of application, and throughout the lifespan of your assistance. You must notify us immediately if your household income significantly changes, such as if you or your partner get a new job.
You must maintain residency within the City of Asheboro for the lifespan of your assistance. You must notify us immediately if you move outside of the City of Asheboro.
You must not receive assistance for the requested utility or housing payments from another agency – no “duplication of benefits.” You must notify us immediately if another entity helps you pay the same utility or housing costs requested here. The UWRC and the City of Asheboro will periodically check with other agencies to verify no duplication of benefits has occurred.
You must agree to provide the UWRC or the City any additional, reasonable documentation we may request for program oversight and reporting purposes. Such information will remain confidential.
Any failure to meet these terms may result in the revocation of assistance and/or termination of payments. Applicants who deliberately misrepresent or withhold information – fraud, in other words – may be held liable to repay any assistance they received.
I, the undersigned, have provided the UWRC with accurate and complete information, to the best of my ability, and fully understand the terms and requirements of this program.
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