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Home My Public Portal AboutAB 06-120 Utility Hardship Status RenewalMcCALL CITY COUNCIL AGENDA BILL Number AB 06-120 Meeting Date June 22, 2006 216 East Park Street McCall, ID 83638 AGENDA ITEM INFORMATION SUBJECT: Utility Hardship Status Renewal Approvals: Department/ Committee/Individual Initials Remarks (Originator/ Support) Mayor 1 Council City Manager Community Development Treasurer originator Clerk Police Department Public Works Golf Operations Parks & Recreation COST IMPACT: Airport FUNDING SOURCE: Library City Attorney TIMELINE: Grant Coordinator Other: SUMMARY STATEMENT: The renewal applicant is an elderly, disabled person. Their sole income is primarily from Social Security in the amount of $652.00 per month ($7,824.00 annually). Attached is a redacted copy of the application for hardship status renewal along with supporting documentation of income and medical statements made on the application. Also, attached is a copy of the 2006 Health and Human Services Poverty Guidelines. Income as stated and supported meets the poverty guidelines listed in the City code. Staff recommends that the hardship status of the applicant be renewed retroactive back to the annual renewal date of April 30, 2006. The hardship relief, if renewed, would be at the base rate of $22.50 per month with a usage limit of 6,000 gallons; the water usage limits for a family of one. Any usage over this limit would be paid by the hardship customer. RECOMMENDED ACTION: Approve the Utility Hardship Status Renewal application retroactive to the renewal date of April 30, 2006. RECORD OF COUNCIL ACTION Meeting Date ACTION CO • ;;;•-• • Applicant Information Customer Number: Service address: Mailing Address: " City: Rented (Please circle) Current employer: Employer address: Phone: City: Position: City of McCall 216 E. Park Street McCall, ID 83638 E-mail: State: r) o 2/1116 Phone: — T - How long? Fax: ZIP Code: Hourly Salary (Please circle) Other Household Residents' with Income Annual income: IF EXTRA SPACE IS NECESSARY, PLEASE REEL FREE TO USE AND ATTACH ADDTTIONAL SHEETS OF PAPER. ... _ Name: SSN: Mailing address: Phone: City: State: Other Residents' Employment Information Current employer: jall&j:L.„ Employe!' address: Phone: City: Position: Total Household income: IEmail: State: Hourly Salary (Please circle) Assets/Income of Other Residents' in Household Bank: Name, Address r) _ Bank: Name, Address, Account Number: ZIP Code: 1 Fax: e_ri- ••••• J Flow long? ZIP Code: IAnnual income: Balance: Account Number: Balance: Please list all nlher assets including net of corresponding debt: Investments, 401K, Real estate and other Type of Asset: Type of Asset: Location: Current Value: Location: Current Value: Please list all properties that have been transferred for market value or less than fair market value in the two years preceding the application. Type of Asset: •J' • I Type of Asset: . .1 N...11'. • Location: Location: Fair market: value at transfer: Fair market: vaiiie at: Transfer: Additional Information • A,th Mediicail. Information City of McCall 21.6 E. Paid;` Street McCall, ID 83638 Please lisl: all other sources of income including, child support, Veterans Pay, Social Security, Alimony, Retirement, Pension, Other. Source of Income: p # - �. l Source of Income: 1 , Source of Income 1pf.h"' M.st current: Income Tax Return must be attached for application to be considered. : ! . ?ry* Monthly Amount: Monthly Amount: /y ( �. Monthly Amount: ' Medical Conditions: Please describe medical condition and physician contact information. in order for medical condition to be considered as a basis for a hardship need the authorization io discuss information rrrust be sr -- - art and attached. --- r 4 [ \ (.A...) S i. (' (\ 1 I' le iy:).(. 0 01..A 0,C ,k 'h', ( . [..)4 e 1-,1 ._.,... _— ':\ ;.ras... \ anr•f n l t� y ts�c Comments and other information you would like to have considered on your application. I certify under penalty of perjury that: the statements made in this application are true and correct. I understand that: any false statements in this application will he grounds for denial and /or revocation of the hardship relief. In addition, I authorize the verification of the information in provided on this form. I have received a copy of this application. Signature of applicant: signature of other Resident: Signature of other Resident:: Signature of other Resident:—�-- Date: Date: Date: FDate-._ Your New Benefit A mount BENEFICIARY'S NAME: .Pin. Your Social Security benefits will increase by 4.1 percent: in. 2006, because of a rise in the cost of living. You can use this letter when you need proof of your benefit amount to receive food stamps, rent subsidies, energy assistance, bank loans, or for other business. How Much Will I Get .And When? • Your new naonthly amount (before deductions) is ,$256.00 • The amount we are deducting for Medicare is $0.00 (If you did not have Medicare as of Nov 20, 2005, or if someone else pays your premium, we show $0.00.) • The amount; we are deducting for voluntary federal tax withholding is $0.00 (If you did not elect voluntary federal tax withholding as of Nov 20, 2005, we show $0.00.) ▪ After taking any other deductions, we will deposit $ 2 56.00 . into your bank account on Jail. B, 2009. If you disagree with any of these amounts, ,you should write to us within 60 clays from the da.t;e you receive this letter.. What If I Have Questions? We invite you to visit our website at www.socialseeuritygov on the Internet to find general information about Social Security. You also can call us at 1-8 DAD-772-1213 and speak to a. representative from 7 a.m. until 7 p.m. on business days. If ,you have a touch-tone phone, )recorded information and services are available 24 hours a day. Our lines are busiest: early in the week and early in the month so, if your business can wait, it is best to call at other tinges. If you are deaf or hard of hearing, you tnay call our TTY number, 1-800-325-0778_ If ,you are outside the United States, you Call contact any ITS. embassy or cons-ulate office, or the Veterans Affairs Regional Office in Manila. Please have your full. nine -digit Social Security claim number available when ,you. call or visit and. include it on. any letter you send to the Social Security Administration. If you are inside the United States, ,you also can visit, your local office. SUITE 301. 1.24:9 S VINNClLI, 1301.SE ID BNC#: 05I31.187134:5000 Over ),, SOCIAL SECURITY I249 S VINNELL WAY SUTIE 101. BOISE ID 83799 N98 1310'7, M4 ES,074,00.5099 000017599 01 AT 0292 p NMCCAlLL IDf 83638 t� t IM ARIeAAIIAAlIAAA[IIAIAE IAAAIRIAARIIIAAII IiRAII iAI[�AiA llil AAl Social Security A.drninistratxon. Supplemental Security Income Notice of Chan.gc i.n Payment :Date: Nov -ember 27, 2005 Claim Number: 1111111111111.1 We are writing to tell you about changes in. your Supplemental Security Income payments. The rest of this letter will tell you more about: this change. Weexplain how we figured the monthly payment amounts shown below can the last page(s) of this letter. The explanation shows l-aow your income, other than. any SCSI payments, affects your SSI payment_ It also shows how we decided how much of your income affects your payment amount. We :include explanations only for months where payinent amounts change, Information About Your Payments e The amount due you beginning January. 2006 will be $367.00. • The amount due you is being raised because the law provides for an. increase in Supplemental Security I.ncotne payments :in January 2006 .if there wa.s an increase in the cost -of -living during the past year. YourPayment Is Based. On These Facts Our records shover that the following income used to figure your payment has also changed — Your increased Social Security benefits —before any deductions for .Medicare premiums— of $256.00_ You should receive the .increased) Social. Security benefit about January 3, 2006. We must count the increase in your benefits for January 2(D(D6 every though we are counting your other income? for November 2005. SSA-1 ,8151 See .Next Wage Page 2 of 5 1.1/27/2005 You Can Review The Information i>:a Y®u.r• Case The decisions in this letter are based on the law. You have a right to review and get copies of the information in our records that: we used to make the decisions explained in this letter. You also have a right to review and. copy the laws, regulations and policy statements used in deciding your case. To do so, please contact us. Our telephone number and address are shown under the heading "If You Have Any Questions." Things To Remember • Your payments may change of your circumstances change. Therefore, you are required to report any change in your situation that may affect your Supplemental Security Income payment. For example, you should tell us if you move, if anyone else moves from or into, your household, if your marital status changes, if income Or resources for you or members of ,your household change, if your medical. condition improves or if ,you go to work. ® You may use this letter when you need proof of your SSJ: payment amount for other assistance programs such as food stamps, rent subsidies, energy assistance, medical assistance, bank loans, or for other purposes. However, if you get another letter saying your SS1 payment is changing again, lase that letter instead. • We may share information about you with oth.er government: agencies that pay benefits_ Agencies use such information to see .if a. person qualifies for Benefits. We sometimes use computer nr>atching to share information and compare our records with those of other Federal, State, or local government agencies. The lave allows us to use computer mat c.hing even if you do not agree. If YOU Disagree With. The Decision If you disagree with the decision, you have the right to appeal_ We will review your case and consider any new facts you have, ® You have 60 days to ask for an appeal. e� The 60 d.ays start the day after you get this letter. We assume ,you dot this letter 5 days after the date on it unless you show o.s tb.at; you did not get it within the 5-day period. • You must have a good reason for waiting more than fill days to ask for an appeal. • To appeal, you must fill out a form called "Request for :Reconsideration." The flan number is SSA -561.. To get this tbrin, contact one of OUT offices_ We can help you fill ol:.>!t the form. SSA• 1,8151 Eddie Droge, MD Dan Ostermiller, MD ;rn Dardis, MD Scots Harris, MD Dave Dall, MD Curt Mcske, Mil Jennifer Gray, MD Rochelle Hawn, FNP Dan Dyde, FNP • Payette Ickes Medical Clinic., PA 1:11. Forest Street Post Orrice Box'tng7 McCall, Idaho R3638 (2_08) 639-2225. Fax.(7oR) fie}- 2.12 e Meadows Valley Medical Clinic 31)n Virginia Avenue Drawer P New Meadows, ldahn R36S9 (208) 347-2-1 Fax:(208) 747-2147 4 Salmon River Medical Clinic 2_14 North Main Post Dfrtce Box36 Riggins, Idaho R35.49 (2.o8) 128-3666 Fax:(208) 62.8-3787 * Council Mountain Medical Clinic :tot Council Avenue, Suite C Posl Office Box r) coupril, Idaho 836i2. (208) 253-491ri rax:(:.oR) September 19, 2005 Todd J. Wilcox, Valley County Public Defender P.O. Box 947 McCall, Idaho 83638 RE- 4111101111111111111111 111111.111111111111 Dear Sir. edical You have requested information � ga lei of 2005- condition in July, August, ulnas had many medical problems in the last five years after having bariatric surgery. She did lose about 200 pounds, but many surgical complications ensued. Her ongoing 'medical problems include chronic hepatitis C; degenerative disc disease with chronic back pain; bipolar disease; nutritional deficits. In March of 2005,11111.11developed a severe infection in her left lower leg. This led to surgery and a prolonged healing period. In late June I saw her for her regular monthly visit. She was tapering her use of pain medication. Her leg was healing nicely. She continued to have nutritional deficits due to her bypass. In July I admitted her to the hospital with dehydration and gastritis. A few days later, she was again treated in the emergency room al. McCall Memorial Hospital for gastritis and vomiting. Also in July, she was treated at St. Luke's Hospital :n Boise by her gastroen rologist for continued dehydration and gastriti The patient was seen in my office on August l" and again on August 9th to assist in adjusting her medications as she had withdrawn from several of her prescriptions. My last visit withenftwas on September 13, 2005. This was a scheduled visit to refill medications. She is now doing better with rare vomiting attacks and no current: dehydration. continues to take medications for gastritis. She also continues to see a gastroenterologist, Dr. Ellen Hunter, for her serious, ongoing problems. Sincerely, Eddie J.roge, M. EJDD:kdm September 20, 2005 RE: Tohom It May Concern: GAIDAH° GYAssocln>Fs, LIP Ms.11111111111111118 followed in our clinic for chronic hepatitis C and abdominal pain. She does have chronic liver disease from hepatitis C, A. liver biopsy in 2003 showed scarring of the liver. Hepatitis C can cause easy fatigability with wealrness .1111111110has had Significant easy fatigability. In addition, with her chronic liver disease she may have decreased metabolism of medications by the liver. With the creased drug metabolism by the liver, she could experience increased tiredness or impaired balance from medications that she has taken including clonazeparn, antidepressants, and narcotics. If I can provide further informatiorn, please contact me with tten consent. Sincerely, A Ellen B. Hunter, M.D. EBH/lnul CC: i 425 W. Bannock • Boise, Idaho 83702 • 208.343. 6458 phone • 208.343. 5031 fax Paul H. Baehr, M.D. • Ellen B. Hunter, M.D. • Philip D. Jensen, M.D. n Mark L Llaird, M.D. • Richard F. Uhlmann, M.D. • Bormie Kim Wain, M.U. • John T. Witte, M.D. • David W. Wood MA. • .4 dirh n Wendt m n 2006 Federal Poverty Guidelines http://www.aspe.hhs.gov/poverty/06poverty.shtml Health C brit tt'r Str teS De }crr i'n(nif of uman Services Skip Navigation • HHS Home • Questions? • Contact Us • Site Map THE 2006 HHS POVERTY GUIDELINES Search One Version of the [U.S.] Federal Poverty Measure [ Federal Register Notice with 2006 Guidelines - Full Text ] [ Prior Poverty Guidelines and Federal Register References Since 1982 ] [ Frequently Asked Questions (FAQs) ] [ Further Resources on Poverty Measurement, Poverty Lines, and Their History ] [ Computations for the 2006 Poverty Guidelines ] There are two slightly different versions of the federal poverty measure: • The poverty thresholds, and • The poverty guidelines. The poverty thresholds are the original version of the federal poverty measure. They are updated each year by the Census Bureau (although they were originally developed by Mollie Orshansky of the Social Security Administration). The thresholds are used mainly for statistical purposes — for instance, preparing estimates of the number of Americans in poverty each year. (In other words, all official poverty population figures are calculated using the poverty thresholds, not the guidelines.) Poverty thresholds since 1980 and weighted average poverty thresholds since 1959 are available on the Census Bureau's Web site. For an example of how the Census Bureau applies the thresholds to a family's income to determine its poverty status, see "How the Census Bureau Measures Poverty" on the Census Bureau's web site. The poverty guidelines are the other version of the federal poverty measure. They are issued each year in the Federal Register by the Department of Health and Human Services (HHS). The guidelines are a simplification of the poverty thresholds for use for administrative purposes — for instance, determining financial eligibility for certain federal programs. (The full text of the Federal Register notice with the 2006 poverty guidelines is available.) The poverty guidelines are sometimes loosely referred to as the "federal poverty level" (FPL), but that phrase is ambiguous and should be avoided, especially in situations (e.g., legislative or administrative) where precision is important. Key differences between poverty thresholds and poverty guidelines are outlined in a table under Frequently Asked Questions (FAQs). See also the discussion of this topic on the Institute for Research on Poverty's web site. I of 3 5/18/2006 4:40 PM 2006 Federal Poverty Guidelines http://www.aspe.hhs.gov/poverty/06poverty.shtml 2006 HHS Poverty Guidelines Persons in 48 Contiguous Family or Household States and D.C. Alaska Hawaii 1 $ 9,800 $12,250 $11,270 2 13,200 16,500 15,180 3 16,600 20,750 19,090 4 20,000 25,000 23,000 5 23,400 29,250 26,910 6 26,800 33,500 30,820 7 30,200 37,750 34,730 8 33,600 42,000 38,640 For each additional person, add 3,400 4,250 3,910 SOURCE: Federal Register, Vol. 71, No. 15, January 24, 2006, pp. 3848-3849 The separate poverty guidelines for Alaska and Hawaii reflect Office of Economic Opportunity administrative practice beginning in the 1966-1970 period. Note that the poverty thresholds — the original version of the poverty measure --- have never had separate figures for Alaska and Hawaii. The poverty guidelines are not defined for Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam, the Republic of the Marshall Islands, the Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, and Palau. In cases in which a Federal program using the poverty guidelines serves any of those jurisdictions, the Federal office which administers the program is responsible for deciding whether to use the contiguous-states-and-D.C. guidelines for those jurisdictions or to follow some other procedure. The poverty guidelines apply to both aged and non -aged units. The guidelines have never had an aged/non-aged distinction; only the Census Bureau (statistical) poverty thresholds have separate figures for aged and non -aged one -person and two -person units. Programs using the guidelines (or percentage multiples of the guidelines — for instance, 125 percent or 185 percent of the guidelines) in determining eligibility include Head Start, the Food Stamp Program, the National School Lunch Program, the Low -Income Home Energy Assistance Program, and the Children's Health Insurance Program. Note that in general, cash public assistance programs (Temporary Assistance for Needy Families and Supplemental Security Income) do NOT use the poverty guidelines in determining eligibility. The Earned Income Tax Credit program also does NOT use the poverty guidelines to determine eligibility. For a more detailed list of programs that do and don't use the guidelines, see the Frequently Asked Questions (FAQs). The poverty guidelines (unlike the poverty thresholds) are designated by the year in which they are issued. For instance, the guidelines issued in January 2006 are designated the 2006 poverty guidelines. However, the 2006 NHS poverty guidelines only reflect price changes through calendar year 2005; accordingly, they are approximately equal to the Census Bureau poverty thresholds for calendar year 2005. (The 2005 thresholds are expected to be issued in final form in August 2006; a preliminary version of the 2005 thresholds is now available from the Census Bureau.) The computations for the 2006 poverty guidelines are available. The poverty guidelines may be formally referenced as "the poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2)." 2 of 3 5/18/2006 4:40 PM 2006 Federal Poverty Guidelines http://www.aspe.hhs.gov/poverty/06poverty.shtml Go to Further Resources on the Poverty Guidelines/Thresholds/Lines and Their History Go to Frequently Asked Questions (FAQs). Return to the main Poverty Guidelines, Research, and Measurement page. Last Revised: January 24, 2006 Hi -IS Home I Questions? I Contact Us I Site Map i Accessibility I Privacy Policy I Freedom of Information Act I Disclaimers The White House I FirstGov U.S. Department of Health & Human Services • 200 Independence Avenue, S.W. • Washington, D.C. 20201 3 of 3 5/18/2006 4:40 PM