1. (a) The following verification requirements shall apply to any individual requesting emergency assistance as described in He-W 699.05:

   1. (1) Individuals shall provide the documentation in (b) below of their emergency situation within 10 calendar days of their request for emergency assistance. Failure to provide the required verification shall result in denial of the emergency assistance request;
   2. (2) Individuals shall provide documentation indicating the amount of assistance necessary to cure the emergency situation;
   3. (3) Individuals shall provide documentation of the personal property resources owned by all members of the assistance group, as described in He-W 699.05 ;
   4. (4) For utility deposits, utility arrearages, and deliveries of home heating fuel, the individual shall provide documentation indicating that energy assistance funds are not available to meet the emergency need;
   5. (5) For deliveries of home heating fuel, the individual shall provide documentation from the fuel delivery company indicating that a payment for the current delivery or a payment for the amount of arrearage from either the individual’s current or past residence will allow a current fuel delivery; and
   6. (6) Individuals shall provide additional documentation indicating that the payment authorized by the department shall cure the emergency situation. If the amount of the emergency need exceeds the maximum emergency assistance provided by the department, as specified in He-W 699.05.

2. (b) Acceptable documentation shall be:

   1. (1) A bill, rental agreement, or other document signed and dated by the landlord indicating the amount of the security deposit;
   2. (2) A bill, or signed and dated statement provided by a representative of the utility company indicating the amount of the utility deposit;

   3. (3) One of the following, if the amount of the security deposit, utility deposit, or home heating fuel delivery, is greater than the maximum allowed by the department, as described in He-W 699.05, plus the individual's personal property resources, as described in He-W 699.05:

      1. a. A signed and dated statement from an outside source indicating that it shall provide the remainder of the deposit or home heating fuel cost;
      2. b. A signed and dated statement from the landlord, utility company, home heating fuel company, or provider stating that the payment authorized by the department shall secure the housing, utility, or home heating fuel; or
      3. c. Documentation that a payment plan has been arranged for the remainder of the deposit or home heating fuel cost;
   4. (4) A termination notice, a bill, or a statement from the utility company indicating the amount of the utility arrearage;

   5. (5) One of the following, if the amount of the back rent, mortgage principal and interest, or utility arrearage exceeds 2 months:

      1. a. A signed and dated statement from the landlord, mortgagee, or utility company indicating that payment of a 2-month portion of the arrearage shall respectively prevent eviction, foreclosure, or termination of utility service;
      2. b. A signed and dated statement from an outside source indicting that it shall provide payment for the remainder of the back rent, mortgage principal and interest, or utility bill; or
      3. c. A signed and dated statement from the landlord, mortgagee, or utility company indicating that a payment plan has been arranged for the balance of the arrearage;
   6. (6) An eviction notice, court order, notice to quit, or a signed and dated written demand for rent for an actual or pending eviction, indicating the name of the landlord and the amount of the back rent;
   7. (7) A notice of foreclosure, court order, or a signed and dated written demand for mortgage principal and interest initiating foreclosure proceedings, indicating the name of the mortgagee and the amount of the back mortgage principal and interest;
   8. (8) A current dated bank statement, or a signed and dated statement from a representative of the financial institution for personal property resources;
   9. (9) Fuel assistance termination letter, or a signed and dated statement from a representative of the organization administering federal fuel assistance payments specifying the reason that fuel assistance is not available to meet the emergency need;

   10. (10) One of the following, if verifying incapacity:

       1. a. A check, letter, or other document from the social security administration indicating receipt of social security disability benefits or supplemental security income benefits; or
       2. b. A physician's statement indicating that the individual is disabled and unable to work for a period of at least 30 days from the date of application for emergency assistance; or

   11. (11) One of the following, if there are unsafe or unhealthy living conditions:

       1. a. Documentation of the unsafe or unhealthy living conditions from a third party, including but not limited to a school nurse, school counselor, social worker, case manager, therapist, housing and support services, town welfare, primary medical provider, or pastoral support; or
       2. b. The individual’s written self-attestation of the unsafe or unhealthy living conditions.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5370, eff 4-13-92; amd by #6672, eff 1-26-98; ss by #6754, eff 5-20-98; ss by #8596, eff 3-30-06; ss by #10563, eff 3-30-14; ss by #10860, eff 6-30-15; amd by #12697, eff 12-31-18; ss by #14299, eff 7-1-25, EXPIRES: 7-1-35