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American Rescue Plan Act (ARPA) Individual Program Proposal

  1. AMERICAN RESCUE PLAN ACT FUNDING APPLICATION – ROANOKE CITY

    This is an application for recovery funds to cover eligible expenses incurred during, and directly related to, the COVID-19 Pandemic. You must give complete, accurate, and truthful information. If you do not provide required documentation, we will not be able to determine your eligibility for assistance. If you knowingly give false, incorrect or incomplete information, you could be prosecuted. Assistance, of up to $1000 maximum, may be received only once per address within a 6-month period.

  2. Intent of Local Program:

    The intent of the program is to assist eligible households (a household includes all members residing at the same address) affected by COVID-19 with providing vendor payments for bills incurred, where assistance for those bills is not readily available in the community.  There will be an online application for assistance requests.  An interview will be held by phone with the applicant to explain “rights and responsibilities” of the program and make any requests for verifications or clarification from the applicant.  The program will utilize the context of the ARPA guidance, which presumes that individuals who are with the low or moderate income range have been affected by COVID-19. The program will run until funds ($500,000) are depleted or 12/31/2024, whichever comes first.

    Types of Assistance Offered:

    • Job training/education
    • Internet/Cable
    • Phone
    • Car payments
    • Car insurance
    • Medical bills
    • Electric
    • Gas (home utility not for vehicles)

    Our local DSS office has been charged with administering $500,000 for use by Roanoke City residents.

    Roanoke City DSS has $500,000 to pay expenses to households “affected by COVID-19, not for items they already received assistance funds”.  

    Funds will be distributed on a first come, first served basis, without regard to race, color, national origin, disability, age, sex, religion or political beliefs.

    We will pay unpaid expenses for the types of assistance offered, up to a maximum payment of $1,000 per household address. Partial payments may be made if at minimum of $100 remains to be applied to an additional bill.

    Assistance may be received once in a 6-month period per household/address.

    Payments for future/unbilled debts or for bills outside of those types listed above will not be made.

    Eligibility Requirements:

    1. An individual will be required to complete one online application for the household, as a request for assistance.
    2. The applicant/household must be a Roanoke City resident
    3. The applicant/household must have been affected by COVID-19 
    4. The household’s gross income should be under 200% of the Federal Poverty Level (FPL) for the household size.
    5. The household must be responsible for unpaid expenses in the types of assistance categories offered.

    Required Verifications:

    1. Residency – bills submitted for requested may serve to verify residency.
    2. Affected by COVID-19 – income under 200% FPL.
    3. Gross income – provide all pay stubs for the 30 days prior to date of application based on frequency of pay (example – 4 most recent if paid weekly, 2 most recent if paid bi-weekly or semi-monthly, 1 if paid monthly).
    4. Bills – must be dated within 30 days of application and be in the name of applicant or current household member.   
    5. All verifications must be submitted within 15 days of the request from the agency.

     Income Limit Chart (200% FPL):

    Numbers of Persons in Household200% Federal Poverty Level (FPL)
    1$2,265
    2$3,052
    3$3,839
    4$4,625
    5$5,412
    6$6,199
    7$6,985
    8$7,772
    Additional Members$787


  3. *Notice*

    Please note that you must complete all applicant information and fields below.

  4. Race*

    Please select one option:

  5. Ethnicity*

    Please select one option:

  6. Please note that you must submit the information/data sets below, per household member.

  7. Race*

    Please select one option:

  8. Ethnicity*

    Please select one option:

  9. Race

    Please select one option:

  10. Ethnicity

    Please select one option: 

  11. Race

    Please select one option:

  12. Ethnicity

    Please select one option:

  13. Race

    Please select one option:

  14. Ethnicity

    Please select one option:

  15. Race

    Please select one option:

  16. Ethnicity

    Please select one option:

  17. Race

    Please select one option:

  18. Ethnicity

    Please select one option:

  19. *All demographic data is being collected for the sole purpose of statistical reporting for the ARPA program.
  20. Has your household experienced a loss or reduction of income directly related to COVID-19 since March 1, 2020?*
  21. Income eligibility will be based on the 2021 200% Federal Poverty Level.

    Please see the chart below:

  22. Numbers of Persons in Household200% Federal Poverty Level (FPL)
    1$2,147
    2$2,904
    3$3,660
    4$4,417
    5$5,174
    6$5,930
    7$6,687
    8$7,444
    Additional Members$757
  23. Does your current income fall below the 200% Federal Poverty Limit for your household size?*
  24. Please list the amount of any current unpaid debts you have that are in direct response to your household income being affected by COVID19:
  25. A PHONE INTERVIEW MUST BE CONDUCTED FOR EACH APPLICATION. A WORKER WILL CONTACT YOU AT THE PHONE NUMBER LISTED ABOVE. YOU WILL HAVE 15 DAYS TO PROVIDE DOCUMENTATION OF UNPAID DEBTS. PLEASE SUBMIT COPIES OF CURRENT BILLS. BILLS MUST BE DATED WITHIN 30 DAYS OF APPLICATION DATE AND BE IN THE NAME OF A CURRENT HOUSEHOLD MEMBER. PAYMENT PROCESSING MAY TAKE UP TO 30 DAYS FROM NOTIFICATION OF APPROVAL FOR THE PROGRAM.
  26. By my signature below, I understand the information contained on this application will not be disclosed or used for any public assistance I may, or my family may, currently receive, or have received in the past. I further understand that any information required to be reported to the Department of Social Services to meet policy guidelines for public assistance is my responsibility to report directly to my caseworker and failure to do so could result in an overpayment to my case, for which I will be held responsible to repay.  Public assistance benefits include SNAP (Supplemental Nutrition Assistance Program), TANF (Temporary Assistance to Needy Families), Medical Assistance, Child Care, and Energy Assistance.

    I certify that I have given true and correct information on this application to the best of my knowledge and belief. I understand that if I give false information, withhold information, or fail to report correct information, I could be prosecuted. I understand that if I help someone complete this form in order to get benefits he or she is not entitled to receive, I may be breaking the law and could be prosecuted.

    I understand that I will not personally receive payment, but payment will be made on my behalf to the vendor, if I am approved, up to a maximum amount of $1,000. I understand that this is not an emergency fund and is not meant to prevent service cutoff, re-possession, or collection.

    I understand the funds I am requesting are not guaranteed and I agree to provide any and all verifications of the above information to the Roanoke City Department of Social Services. I understand no applications will be approved without proper verification and that monies will be awarded on a first come, first served basis without regard to race, color, national origin, disability, age, sex, religion, or political beliefs. I understand the decision of the Director of Social Services will be final.

  27. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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