Effective January 2025, the qualification criteria for this program has changed. Please read this page carefully before submitting an application for your patient.
Applications are accepted for a 10-day window each month (the first and last 5 calendar days).
The purpose of this program is to prevent utility shutoffs for patients contending with temporary financial hardships. It is our policy not to assist patients with payments they cannot maintain on their own.
This assistance is limited to a one-time assistance for either rent (including the rent eviction prevention assistance) OR utilities.
Patients who have previously received rent or utility assistance with NKF AZ prior to January 2025 will not be eligible to receive this assistance.
The maximum household income cannot exceed 200% FPL (See FPL Chart). Income for ALL individuals living at the address must be reported on the Financial Statement.
NKF AZ will pay up to two months in arrears for a maximum of $800.
NKF AZ does not assist with late fees, reconnect fees, or other penalties. Patients must be prepared to pay any remaining balance not covered by NKF AZ in order to prevent the utility shutoff.
Patients must attempt to set up payment arrangements with the utility company before applying for NKF AZ utility assistance. If a patient is unsure of how to do this, please review the shutoff notice with them to help them find the phone number they need to call, per the notice.
Forms/Documents:
- To start a new Utility Shutoff Prevention application go to https://www.GrantRequest.com/SID_6273?SA=SNA&FID=35018 Note: The first page of this application is a checklist to help you ensure you have all required documents and information before you submit.
- To access a saved or previously submitted application go to https://www.GrantRequest.com/SID_6273?SA=AM
- A Utility Assistance Application and Consent form with Financial Statement (the Financial Statement is the last page of the PDF) giving NKF AZ permission to contact the utility company must be signed by the patient.
- When the patient’s name is not on the bill, the Consent must be signed by the responsible party and additional verification that the patient is living at the address will be required. This may include a copy of their Arizona state ID that lists the address, a bill in the patient's name that has been sent to that address (no "junk" mail), or some other formal document mailed to the patient at that address.
- English Utility Assistance Application and Consent
- Spanish Utility Assistance Application and Consent
Renewal:
- N/A