Cuyahoga County

Veterans Service Commission Ph: 216.698.2600 • Fax: 216.698.2650 Email: [email protected] 1849 Prospect Avenue • Suite 150 • Cleveland, OH 44115

2014 Dear Fellow County Veteran, Veteran Dependent, and/or Active Duty Military Personnel: The Cuyahoga County Veterans Service Commission is responsible for providing a number of services to County veterans and their dependents. A partial list of these services includes:

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TEMPORARY FINANCIAL ASSISTANCE: Takes the form of direct financial aid for rent/mortgage, utilities, food, clothing, personal hygiene, and newborn infant needs. To qualify for this assistance, the veteran or his dependents must establish financial need and hardship. Requirements to document financial hardship are described on the next two pages of this information packet. Please call 216-698-2632 to learn more on how to obtain CCVSC veteran financial assistance.

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VETERAN TRANSPORTATION ASSISTANCE: Provides transportation to appointments at the Veterans Administration Medical Center facilities. This assistance is available to all veterans regardless of financial need and takes the form of RTA bus tickets provided at no charge by the CCVSC. Please call 216-698-2632 to learn more on how to obtain CCVSC veteran transportation assistance.

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VETERAN SERVICE OFFICERS: Help veterans deal with paperwork and expedite claims filed for Veterans Administration benefits. Veteran Service Officers will assist veterans in applying for VA disability pensions, widow’s pensions, service-connected compensation, dependency & indemnity compensation, increases/appeals of VA claims, etc. To meet with a Veteran Service Officer, please telephone 216-698-2393.

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MEMORIAL AFFAIRS: Provides eligible County veterans with free burial plots in designated veteran sections of public cemeteries, as well as military gravestones at no cost. In addition, those families of veterans who demonstrate financial hardship may qualify for up to $999 towards funeral home expenses associated with the preparation of a dignified burial. Please call 216-698-2655 or 216-698-2635 for more information.

The Cuyahoga County Veterans Service Commission provides a wide variety of other services to area veterans and their dependents. Please contact us at 216-698-2632 to receive an informational brochure. As a veteran, you have served your nation, state and county. In your time of need, please call upon your fellow veterans at the Cuyahoga County Veterans Service Commission if we can be of assistance. Our hours of operation are Monday-Friday from 8:00 a.m. – 4:00 p.m. For the Commission,

Jon Reiss Executive Director

“Veterans Helping Veterans Since 1886”

Internet • http://vsc.cuyahogacounty.us

Applying for Temporary Financial Assistance Eligibility Requirements Section 5901.08 of the Ohio Revised Code establishes eligibility for financial assistance from county veteran service commissions. To qualify for assistance, an applicant must demonstrate financial need and unexpected hardship. Additionally, the applicant must be a veteran, an active duty member of the Armed Forces of the United States, or the spouse, surviving spouse (widow/widower), dependent parent, minor child, or ward of a veteran or active duty member of the Armed Forces of the U.S. Active duty must be for purposes other than training. Applicants must have been a bona fide resident of Cuyahoga County for at least three (3) months prior to the date of application. Required Documentation To expedite the processing of a claim for financial assistance, all applicants are required to present the following information at the time of application. Failure to produce this required documentation at the time of application may cause delays. Basic Information: • • • • •

• • • • •

DD-214 and/or DD-215 (active duty assignment) Verification of Cuyahoga County residency, i.e. valid Ohio driver’s license or state id, mortgage/lease verification Social Security card for yourself and all members of your family. If a card is lost the applicant must bring in official verification from the Social Security Office that includes full name and assigned number Marriage certificate (not license) Divorce decree or legal separation papers. If the applicant claims to be separated, but is unable to provide legal evidence of the separation, he/she will be required to submit a notarized statement certifying the separation or a letter from his/her attorney verifying this separation Death certificate, if appropriate Birth certificate(s) or custody papers of children Documentation formally verifying any legal name changes Correction facility release papers (if incarcerated within the last 12 months) Household verification form (contained in this packet), completed by landlord. (This item is required at each visit)

Income and Asset Information: • •

Payroll check stubs for past 4 weeks for applicant and spouse Current letter from a medical physician (not a chiropractor) clearly stating that the applicant/spouse is unemployable

• •

Wage report for past 30 days (from temporary employment agencies) If unemployed, an Inquiry Response form completed by the Ohio Bureau of Employment Compensation. To receive a copy of the form, please call 1-877-644-6562 or use their website: unemployment.ohio.gov to file for unemployment compensation and to request that a copy of this form be mailed to your home *Note: Takes approximately 5 business days

Verification of income from: • • • • • • • • •

VA pension or compensation received Social Security income/disability payments received Union benefits received Workers’ Compensation received Retirement payments received, such as State PERS/FERS, military pensions, union or company pensions Rental income (statement from tenant) If self employed, monthly profit and loss statement for the last 30 days or quarterly estimated payments for federal and state taxes Child support Verification of all other types of income not noted above

Expense and Liability Information: • • • • • • • •

A printout of all activity for the past 60 days from all checking, debit, savings, direct pay debit card accounts and credit unions All credit card statements (last 2 months) Verification of next rent or mortgage payment due, i.e. rent receipt, current mortgage statement All current utility bills Auto payment verification (to include leased vehicles, motorcycles, recreational vehicles, and boats) Estimates/Receipts for other unexpected expenses (last 60 days) Medical, vision and dental bills (last 60 days) Police and fire department reports if unexpected theft, fire, or other losses (last 60 days)

To assist in the processing of an application for financial assistance, the client may be required to provide additional documentation. Please understand that the Veterans Service Commission may request this information to better serve a given client’s individual case needs. Please direct questions pertaining to information required for this application to the CCVSC Intake (216-698-2632) or the Financial Assistance Manager at (216-698-2621).

A Note on Fraud: Submission of any false information during the application process may lead to criminal prosecution, as well as automatic rejection of the application for aid. Every applicant seeking financial assistance from the Veterans Service Commission will be required to sign a statement indicating that all information submitted on the application is truthful and accurate. Clients who submit fraudulent case information are prohibited for all future Veteran Service Commission assistance.

Items That Can Be Considered Expenses

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Monthly Expenses

Cable/Satellite Car Payment Car Repair Thld Shoes Child Care Child Support Clothing f-=-­ - ­ Credit Card I=­ ---­ Dental Fees Diapers -­ Doctor Fees Education Assistance Electric Food ~ Oil/Propane "Furniture '-=­ Gas Gasoline Home Repair Household Items 10 Card/vehicle registration r.-­ Income Tax Insurance r:----:­ Internet Layette Lot Rent Medical Transportation Medications Mortgage/Condo Fees Other Pay Day Loan Personal Hygiene Personal Loan Propert'(. Taxes Rent Rent - Deposit Rent - Late Charges 'School Supplies Secondary Mor.tgage Storage Fee Taxi f-::--' Telephone Transportation/Bus fare Vision Water/sewer

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Income Sheet (All income received in the last 30 days must be included)

Unemployment Compensation: _ _ _ _ __

VA pension/compensation: _ _ _ _ __

Wages: _ _ _ _ __

Food Stamps: _ _ _ _ __

Social Security: _ _ _ _ __

Retirement/Pension: _ _ _ _ __

Child Support: _ _ _ _ __

DIC: - - - - - Pay Day Loan: _ _ _ _ __

Welfare/ADC/OWF: _ _ _ _ __

Income Tax Refund: _ _ _ _ __

Federal Retirement: _ _ _ _ __

OPERS: _ _ _ _ __

VA Education Benefits: _ _ _ _ __

Other:

Source:

Other:

Source:

Other:

Source:

Other:

Source:

Other:

Source:

Cuyahoga County

Veterans Service Commission Ph: 216.698.2600 • Fax: 216.698.2650 Email: [email protected] 1849 Prospect Avenue • Suite 150 • Cleveland, OH 44115

Household Verification Form (To be completed by the landlord or owner) Applicant’s Name Address City

_______________________________________________________________

_____________________________________________________________________

_____________________ Zip Code ____________ Phone Number ____________________

How much rent or mortgage does entire household pay? How much rent does applicant pay per month? Who do you pay your rent to?

_________________________________

_______________________________________

_______________________________________________________ (Name of Business or Landlord/Proprietor)

Rent due date?

_______________________________________________________________

Last date that rent was paid? _________________________________________________________ Does applicant pay utilities?

Yes

________________

No

_____________________

If yes, which utilities and how much? Gas _______________ Electric _____________

Water ______________________

Does anyone in the household receive shelter or utility assistance from any government agency, (for example, section 8, HUD, Metropolitan housing)? Item? _____________________________

How much? _____________________________

List all people who now reside at this address: First and last name __________________ __________________ __________________ __________________ Person filling out this form

Relationship to applicant ___________________________ ___________________________ ___________________________ ___________________________ ________ Landlord Signature: Address: Phone:

“Veterans Helping Veterans Since 1886”

Date moved in ______________________ ______________________ ______________________ ______________________

_______ Property Owner

______________________________________________ ______________________________________________ _________________ Date: ________________ Internet • http://vsc.cuyahogacounty.us