Required Documents for Economic Assistance Programs

A household is defined as anyone living under your roof.

  • Photo ID (Driver’s license or State ID)
  • Social Security Cards for all household members
  • Proof of disability if disabled
  • Proof of U.S. citizenship for all household members(U.S. birth certificate/ hospital birth record, U.S. passport, U.S. voter registration card, OWF award letter, U.S. military record, or other government documents that specify U.S. citizenship)
  • Most recent utility bills (gas and electric) Non-Regulated utility customers will need to provide corresponding bills showing the electric portion amount and co-payment for non-electric balance.
  • Landlord’s name, address & phone number (a lease is required for all new services)
  • Proof of income:


30 day verification from ALL sources for ALL household members that are 18 years of age and older including, but not limited to: weekly/bi-weekly paystubs, social security/SSDI, VA or disability benefits, pensions, unemployment, TANF, utility allowance

12 month verification is needed for:  self-employment and seasonal employment (teachers, construction workers, landscapers and etc.).

Most recent filed IRS 1040 is also required.


90 day verification from ALL sources for ALL household members that are 18 years of age and order.

If the household income is below 30% of the federal poverty guidelines, you must may be required to provide further documentation to process your application. 

Such documentation may include:  letters of support (signed and dated with address and phone number of those individuals with specific details/amounts of assistance), child support received, gifts, foster care, adoption assistance, VA disability, senior employment, Ohio waiver  program, income earned by dependent minors, tax refunds/rebates, military allowances, PRC, FEMA, proceeds from reverse mortgage, IRS Tax Transcripts.

    • All Household members claiming zero income must be present and complete a self-declaration form.
    • All zero income HOUSEHOLDS must provide an IRS tax transcript or verification of non-filing.

This can be done by:

    • Phone: 1-800- 908-9946 (this method requires the customer to provide their Social Security Number, date of birth, street address, and zip code. Please allow 5 to 10 calendar days)
    • In Writing
      • Internal Revenue Service (IRS)
      • Return and Income Verification Services (RAIVS) Team
      • (RAIVS) Team
      • PO Box 145500
      • Stop 2800 F
      • Cincinnati, Ohio 45250
      • Fax #1-859-669-3592
    • Online
    • Visiting a local IRS Office
      • Akron Office- 2 S. Main St., Akron, OH 44308
      • Canton Office- 301 McKinley Ave. SW., Canton, OH 44702
      • Mansfield Office- 180 N. Diamond St., Mansfield, OH 44902

The forms below can be accessed and may be required to process your application.

Self-Declaration Form
Seasonal Employment Verification Form
Employment Verification Form
Self-Employment Income and Expense Form

1 yr Medical Eligibility Form

3yr Medical Eligibility Form


Print this list for your records.