COVID-19 UTILITY RELIEF PROGRAM Utility Arrearage Assistance

CARES Utility Relief Funds

The amended budget for the Commonwealth of Virginia, signed by Governor Northam on November 18, 2020, allocated $100 million of federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funds towards relief for utility customers whose accounts are in arrears (Cares Utility Relief Funds).

The City of Hopewell (Hopewell Water Renewal) is anticipating an award of funds through the CARES Utility Relief Funds to provide assistance to City customers for their past due wastewater bills. The funds offer relief to customers who have fallen behind on wastewater bill payments due to a loss or reduction in income due to the COVID-19 pandemic.

APPLICATION

Date (required)

Account Number (required)

Amount Due on Current Bill (required)

Address (required)

Address Line 1

Address Line 2

City

State

Zip Code

Phone (required)

Customer Type

RESIDENTIAL CUSTOMERS – COMPLETE THIS SECTION

Name of Residential Account Holder (required)

First

Last

For residential customers, place a mark beside applicable cause of economic hardship if you or a person in your household has experienced a loss of income due to the COVID-19 pandemic. Check all that apply. (required)

(describe)

COMMERCIAL CUSTOMERS – COMPLETE THIS SECTION

1. Name of Non-Residential Account Holder (required)

First

Last

Property Name

Is the utility fee arrearage due to economic hardship experienced by the customer as a result of the COVID-19 pandemic? (Check Y/N) (required)

YES (Eligible for relief; provide explanation below)
NO (Not eligible for relief)

4. Provide and explanation of the COVID-19 related economic hardship: (required)

This CARES Act Assistance Application:

* Will provide assistance for bills dated March 1, 2020 to December 30, 2020, and may not be used for past due amounts prior to this time period.
* Is designed to be a one-time opportunity, with only one payment per household (for residential) or account holder and their successors (for commercial).
* May only be used to pay wastewater charges. It will not be applied to refuse or storm water charges. These amounts are still due.

Applicant’s Certification:

* I desire to receive any assistance to which I am legally entitled under this program and its specifications.
* I certify that the reason I am eligible for this CARES Act assistance is correct to the best of my knowledge and belief.
* I understand that my signature on this form gives permission for the City of Hopewell (Hopewell Water Renewal) to verify records as necessary to verify my eligibility for assistance.
* I certify that this account/customer has not received CARES act relief for any of the arrearages I am applying for from any other source including Rebuild VA Grants.
* I understand that if I give false information or withhold information in order to make myself eligible for benefits that I am not entitled to or apply for assistance at more than one site, I can be prosecuted for fraud and/or denied assistance in the future.
* I understand that the agencies involved in this program may verify all of the information which I have provided.
* (For residential applicants): I am the only person living in the household at the address shown on this form who has applied for this assistance; or
* (For commercial applicants): I am the only person who has applied for/on behalf of the account holder, including their successors, at the address shown on this form and that I am not a government account holder.

Printed Name (required)

Title (for Commercial Accounts) (required)

For Office Use Only

Date Received__________ Screened Date__________ Amount 60+ Past Due: $__________ Amount 30+ Past Due: $__________ Total: $__________