Followup questions - utility bills — Colorado Helping Hub

Follow-up questions - utility bills

In order to continue the review process, we need to collect some additional information as required by our documentation process. Please provide detailed information by answering the questions below and uploading a copy of your ID. By filling out the information below, you certify that the information provided is truthful and complete to the best of your knowledge. Providing this information does not guarantee approval. Please note that your Application cannot move forward in the review process until this information is received.

Name

First Name

Last Name

Have you sought or are you seeking assistance from other nonprofit organizations or Programs?

If yes, names of the other organization(s). Include names of Food Banks, churches, charities, Government Programs, etc.

How many people are in your household?

How many in your household are under the age of 18?

Please list the ages of your children.

Monthly gross income:

Please estimate your household monthly gross income. Include wages from jobs, income from Social Security (Medicare/Medicaid), income from disability, income from child support or alimony, income from pension or retirement plan, and income from a small business.

If you are seeking utility bill assistance, please answer the following questions:

- Are you currently behind on a utility bill? - How much is your past due amount? - Which utility company? - Are you able to show a bill, invoice, or statement from your utility company showing the past due amount? - Is your utility company willing to accept a partial payment without disconnecting your service?

Additional information you'd like for us to take into consideration as we review your Application:

By clicking “Submit”, you agree that you have answered these questions truthfully and complete to the best of your knowledge.

The information provided to Colorado Helping Hub is 100% private, and we commit to keeping your information safe and confidential.