Ross County Community Action is currently offering a variety of programs to provide assistance with past due utility bills, rent, and mortgage for households financially impacted by Covid-19.  In order to streamline the application process and to ensure individuals are eligible and are able to maximize the resources available, we need to ask you a few questions to start the process.  Please complete this short request form and a Community Action representative will follow back up with you to start the application process.  If you have already submitted an application or other documentation for Utility/Rental Assistance by email or dropping it off at our office, on or after November 2, 2020, you do NOT need to complete this form.  Doing so may duplicate your application and possibly delay your assistance.  Thank you!

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* 1. What is your contact information?

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* 2. Do you have an alternate phone number where you can be reached?

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* 3. What is your preferred method of contact?

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* 4. Are you a Ross County Resident? 

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* 5. Has your household been financially impacted by COVID-19?

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* 6. How have you been financially impacted?  Please select all that apply.  

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* 7. Some programs have income guidelines.  Are you at or below the federal income guidelines as listed below?   

Size of Household          12-month income

           1                                up to $25,520

           2                                up to $34,480

           3                                up to $43,440

           4                                up to $52,400

           5                                up to $61,360

           6                                up to $70,320

           7                                up to $79,280

           8                                up to $88,240

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* 8. What do you need assistance with?

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* 9. Are you scheduled for a utility shut-off or eviction within the next 5 days?

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