Check to see if you may be eligibleHousehold(Required)Choose...12345678910+The number of people living in your residenceCounty(Required)Choose...AdamsBentonChelanCowlitzDouglasFranklinGrantGrays HarborIslandKitsapMasonSkagitSnohomishWalla WallaWhatcomYakimaGross Annual Income(Required)Household income before taxes* Calculator results are estimates and may not reflect your final eligibility. If you are unsure whether you qualify, we encourage you to apply for CARES.Income from Table(Required)Difference(Required) URLThis field is for validation purposes and should be left unchanged.Cascade Natural Gas offers CARES bill assistance to income qualified households. CARES applies a bill discount to reduce the amount due on monthly bills for 24 months. If applicable, CARES also offers a grant to be applied toward any past due amount on an active account. To apply, please complete this form with the assistance of your local community-based organization (CBO), which will process your application to determine if you qualify. If your household qualifies for the CARES program, you will receive a communication from your local Community Action Agency notifying you how to apply for other assistance programs including Low-Income Home Energy Assistance Program (LIHEAP) and the CARES arrearage relief grants.Cascade Natural Gas Account InformationCustomer name on account(Required) First Last Date of Birth(Required) Service Address(Required) Street Address City County How did you learn about CARES? Local Community Action Agency Community-Based Organization Cascade Customer Service Cascade Letter, Postcard, Brochure Cascade Website (cngc.com) Cascade Social Media Cascade Email Insert included with Cascade Bill Message on Cascade Bill Call Received from Cascade Cascade Door Tag Non-Cascade Website Ad Google Ad Streaming Audio Ad Streaming Video Ad Word of Mouth Other UnknownAre you interested in learning about our FREE Weatherization Program? Yes No Not at this timePlease provide your monthly income by income typePlease note: Cascade will randomly select up to five percent of applications for its income verification process. If you are selected for the income verification process and are unable to provide documentation supporting your declared income, you may be removed from the CARES Program.PLEASE NOTE: Eligibility for CARES is based on the adjusted gross income and number of all residents living in your household.Earnings (taxed)Pay checks from an employer (receives W2 at end of year)Earnings (not taxed)From regular employer but no W2-paid in cash or 1099)Self-EmploymentPaid in 1099 or files business Schedule C for taxes. May have business license.SSI (Supplemental Security Income)Welfare version of Social Security for those without enough hours to qualify for SSA (income may vary dependent on other household income)SSA/SSDI (Social Security)Social Security Retirement (min age 62) or Social Security DisabilityL&I / Workers CompensationCan be paid biweekly or monthly; may be through law officeUnemployment CompensationRetirement Pension (traditional)Receives regular monthly payments like an annuityOld Age/Pension (foreign)SSA equivalent in other countries (need currency converted to US Dollars)Investments/Dividends/IRAs or AnnuityState Cash Assistance (TANF/GA/ABD/SSI SP)Spousal or Child SupportOdd jobs (paid in cash only)Mowing lawns, cleaning, babysitting (inconsistent work)Military PayTribal Cash benefits (paid quarterly/semi- or annually)TOTAL*Requires proof of income to qualify for full deduction of VA Disability benefits if pulled for verification.Names of residents living in your homeCustomer Acknowledgement(Required) AcknowledgementBy checking this box, the Cascade customer acknowledges that submission of their application or participation in the CARES Program is implicit consent that a Community Action Agency may access the customer’s Cascade Natural Gas account information for the purpose of qualifying the customer for additional services.(CBO Name) Representative(Required)Date(Required)
