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Qualify by certifyng you belong to one of programs listed below, programs with (*) DO NOT require proof. Remaining programs require an award letter from SSA or State Agency Stating that you receive the benefit, or a similar official document. PROVIDE COPY ONLY

 

1 Electrical Universal Service Program *

2 Supplemental Nutrition Assistance Program *

3 Maryland Energy Assistance Program *

4 Public Assistance to Adults *

5 Temporary Cash Assistance ( TANF ) *

6 Supplemental Security Income ( SSI )

7 Temporary Disability Assistance Program

 

PROGRAMS ARE VALIDATE BY A STATE AGENCY ( NO PROOF REQUIRED )

 

 

Qualify by checking ythe number of people in your family and your monthly income, attach proof of income such as last year's Federal or State Income tax return, a Social Seciruty Statement of benefit, a letter from your employer, pay stubs from 3 consecutive months, an Unemployment or Workmen's compensation statement of benefits, a Retaiment/Plan statement of benefits or a Divorce decree, child support award, or other official containing income information. PROVIDE COPY ONLY

 

Pers.in Family             Annual Income     Monthly Income

or House hold

1 ....................................   $ 15,755     ..............   $ 1,313

2 ....................................   $ 21,236     ..............   $ 1,770

3 ....................................   $ 26,717     ..............   $ 2,226

4 ....................................   $ 32,198     ..............   $ 2,683

5 ....................................   $ 37,679     ..............   $ 3,140

6 ....................................   $ 43,160     ..............   $ 3,597

7 ....................................   $ 48,641     ..............   $ 4,053

8 ....................................   $ 54,122     ..............   $ 4,510

    

 

 

 

 

 

 

 

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