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For Assistance Call 1-833-687-0967Program OverviewCALIFORNIA COVID-19RENT RELIEF PROGRAMThe California COVID-19 Rent Relief Program has addressed months of accumulated rental debt and providedassistance for current and future rent, keeping hundreds of thousands of Californians housed who mightotherwise have been forced to leave their homes because of the economic impact of the pandemic.To ensure that rental protections continue to be extended to households in need and that rental assistancecontinues to flow to tenants and their landlords, the state will prioritize Californians most at risk of eviction andhomelessness- those earning extremely low to no income.Using the scale below, we will prioritize payments for those most at risk of eviction based on their householdincome as compared to Area Median Income or AMI*. First Tier: Payments for households at 30% or less of AMISecond Tier: Payments for households at 31-50% of AMIThird Tier: Payments for households at 51-80% of AMINot eligible: Households at 81% or higher of AMIWhat help is available?If you owe rent (“back rent” or “arrears”) we can help.If you cannot pay your rent now or are concerned about paying next month’s rent we can help.We can also help with utility bills that you owe now or that you have not paid.Who qualifies for help? California Only You must live in California. All California residents may apply regardless of immigrationstatus. Income Qualified If you experienced financial hardship during COVID-19 you are likely eligible forassistance. You are already qualified if you receive benefits from programs like MediCal, WIC, orCalFresh, or can demonstrate similar hardship.1 of 44

For Assistance Call 1-833-687-0967 Affected by COVID-19 This does not mean you had COVID. For example, if you lost your job, hadyour work hours reduced, were unable to find employment, had additional child-care or healthcarecosts, or had other increased costs due to the pandemic, you meet this requirement. Payment Priorities Assistance is prioritized by need so be sure to get your application in while theprogram is open, and while funds are still available.Simple 3-Step Application Process1. Fill out the application to the best of your ability. It will help us to determine if you qualify for assistanceand make sure we send you the right amount of money.2. The State of California will notify your landlord that the Rent Relief process is underway. If yourlandlord participates in the program the payment will go out faster.3. Once you are done your Case Manager will help you if more information is required. Please respond toany requests for additional information so that your application is complete! You can indicate whetheryou want to be contacted by email or phone in the application. If you do not respond we will not be ableto pay your rent or utilities.Most people take about 30 minutes to complete this secure and private application. We will not share yourinformation without your permission.What can I do to speed up the process? Let your landlord know you have applied. You can use our sample letter here( info/renter to landlord letter.pdf ) to tell your landlord youhave applied to the program.Have your 2020 tax return, W-2, 1099, or other income information, such as paystubs, or publicassistance approval/recertification letters handy. You will need to upload it later. You can find out moreabout what type of income information you will need to provide at rr/program overview.html.Watch for emails and/or respond to calls from the California COVID-19 Rent Relief Program.Make sure you are uploading the right information. We accept photos, scans, electronic documents,and text files to make it easier to upload your information.Provide good contact information for both you and your landlord if possible. Providing your landlord’semail address and phone number will help speed up the process.What should I expect from the program? Payments for utility bills will go directly to your utility provider. You will be notified when your utilitiesare paid.If your landlord is participating in the program then payment for rents will go directly to your landlord.You will be notified via email when your landlord has been paid.If your landlord does not participate in the program, then you will be paid directly.We do not share your application information with your landlord. Your information is private. Noinformation regarding legal status will be provided to any other government agency.You can request information on the status of your application by either logging into this applicationportal, or by calling toll free 1-833-430-2122.2 of 44

For Assistance Call 1-833-687-0967What if I need help?There are local partners across the state who can help you with your application for free. Local partners canhelp you over the phone and can make an in-person appointment to help complete your application. You canset an appointment with a local partner near you by calling toll free 1-833-687-0967.FAIR HOUSINGThe California COVID-19 Rent Relief Program follows all federal and state requirements related to fair housingand discrimination. The State also takes steps to affirmatively further fair housing in California and to ensurethat all of its programs are free of discrimination. To learn more about fair housing and anti-discrimination,please go here: -for-Tenants-and-Landlords.REASONABLE ACCOMMODATIONIf you or anyone in your household is a person with disabilities and requires a specific accommodation to applyfor this Program, please contact the program call center by phone at 1-833-430-2122, send an email, or dial through the 711 access.If reasonable accommodations are required, the program will guide you to a local partner organization that canassist you with your application.COMPLETED APPLICATION DEFINITIONPer Health and Safety Code 50897:A completed application means an application for which a landlord or eligible household, as applicable, hasprovided all the necessary contact information and documentation required for a government rental assistanceprogram to initiate a review of the application for eligibility.3 of 44

For Assistance Call 1-833-687-0967A. EligibilityThe following questions will help determine whether your household meets basic eligibility for the California Covid-19 RentRelief program.A.1. Are you seeking assistance for Rent and/or Utilities for your primary residence located inCalifornia? Yes NoIf you selected “No”, you are not eligible for assistance in the California COVID-19 Rent Relief Program.A.2. Please identify your county of residence in the following table. Use the columns to identify the number ofpeople in your household. Your income must be below the amount identified for your county for yourhousehold size.4 of 44

For Assistance Call 1-833-687-0967Household SizeAlpine CountyAmador CountyButte CountyCalaveras CountyColusa CountyContra Costa CountyDel Norte CountyEl Dorado CountyGlenn CountyHumboldt CountyImperial CountyInyo CountyKings CountyLake CountyLassen CountyLos Angeles CountyMadera CountyMariposa CountyMendocino CountyModoc CountyMono CountyNapa CountyNevada CountyOrange CountyPlacer CountyPlumas CountySan Benito CountySan BernardinoCountySan Luis ObispoCountySan Mateo CountySanta Cruz CountyShasta CountySierra CountySiskiyou CountySutter CountyTehama CountyTrinity CountyTulare CountyTuolumne CountyVentura CountyYolo CountyYuba County12345678 45,500 43,650 39,050 45,750 39,050 76,750 39,050 50,750 39,050 39,050 39,050 41,550 39,050 39,050 40,450 66,250 39,050 39,050 40,500 39,050 44,200 63,050 50,300 75,300 50,750 40,950 54,700 52,000 49,850 44,600 52,300 44,600 87,700 44,600 58,000 44,600 44,600 44,600 47,450 44,600 44,600 46,200 75,700 44,600 44,600 46,300 44,600 50,500 72,050 57,500 86,050 58,000 46,800 62,500 58,500 56,100 50,200 58,850 50,200 98,650 50,200 65,250 50,200 50,200 50,200 53,400 50,200 50,200 52,000 85,150 50,200 50,200 52,100 50,200 56,800 81,050 64,700 96,800 65,250 52,650 70,300 64,950 62,300 55,750 65,350 55,750 109,600 55,750 72,500 55,750 55,750 55,750 59,300 55,750 55,750 57,750 94,600 55,750 55,750 57,850 55,750 63,100 90,050 71,850 107,550 72,500 58,500 78,100 70,150 67,300 60,250 70,600 60,250 118,400 60,250 78,300 60,250 60,250 60,250 64,050 60,250 60,250 62,400 102,200 60,250 60,250 62,500 60,250 68,150 97,300 77,600 116,200 78,300 63,200 84,350 75,350 72,300 64,700 75,850 64,700 127,150 64,700 84,100 64,700 64,700 64,700 68,800 64,700 64,700 67,000 109,750 64,700 64,700 67,150 64,700 73,200 104,500 83,350 124,800 84,100 67,900 90,600 80,550 77,300 69,150 81,050 69,150 135,950 69,150 89,900 69,150 69,150 69,150 73,550 69,150 69,150 71,650 117,350 69,150 69,150 71,750 69,150 78,250 111,700 89,100 133,400 89,900 72,550 96,850 85,750 82,250 73,600 86,300 73,600 144,700 73,600 95,700 73,600 73,600 73,600 78,300 73,600 73,600 76,250 124,900 73,600 73,600 76,400 73,600 83,300 118,900 94,850 142,000 95,700 77,250 103,100 44,250 50,600 56,900 63,200 68,300 73,350 78,400 83,450 54,800 102,450 78,050 39,800 47,350 39,050 39,050 39,050 39,050 39,050 41,650 62,800 49,650 39,050 62,600 117,100 89,200 45,450 54,100 44,600 44,600 44,600 44,600 44,600 47,600 71,800 56,750 44,600 70,450 131,750 100,350 51,150 60,850 50,200 50,200 50,200 50,200 50,200 53,550 80,750 63,850 50,200 78,250 146,350 111,500 56,800 67,600 55,750 55,750 55,750 55,750 55,750 59,500 89,700 70,900 55,750 84,550 158,100 120,450 61,350 73,050 60,250 60,250 60,250 60,250 60,250 64,300 96,900 76,600 60,250 90,800 169,800 129,350 65,900 78,450 64,700 64,700 64,700 64,700 64,700 69,050 104,100 82,250 64,700 97,050 181,500 138,300 70,450 83,850 69,150 69,150 69,150 69,150 69,150 73,800 111,250 87,950 69,150 103,300 193,200 147,200 75,000 89,250 73,600 73,600 73,600 73,600 73,600 78,550 118,450 93,600 73,6005 of 44

For Assistance Call 1-833-687-0967Based on the number of people in your household, is your household income below the income limit reflectedin the table? Yes: Continue to Question A.3. No: You are not eligible for assistance in the California COVID-19 Rent Relief Program. I did not see my county on the table: Continue to Question A.3.A.3. Some Cities and Counties are operating their own local rental assistance program. If you live inone of the cities or counties listed below, you may need to apply to your local program. Use the linkprovided to access the appropriate state or local program for your City or County. If your city or countyis NOT listed below, continue to the next question.County or CityAlameda CountyFremontOaklandFresno CountyFresnoKern CountyBakersfieldProgram TypeLocal ProgramLocal ProgramState and LocalLocal ProgramLocal ProgramLocal ProgramLocal ProgramLong BeachLocal ProgramMarin CountyMonterey CountyLocal ProgramLocal ProgramAnaheimSanta AnaRiverside CountyMoreno ValleyLocal ProgramLocal ProgramLocal ProgramLocal ProgramRiversideSacramento CountySacramentoLocal ProgramLocal ProgramLocal ProgramSan BernardinoLocal ProgramSan Diego CountyLocal ProgramChula VistaSan DiegoLocal ProgramLocal ProgramStocktonLocal ProgramSonoma CountyLocal continue with this community n economic development/housing/eviction prevention program ousing/housing-and-renter-support/6 of 44

For Assistance Call 1-833-687-0967If you don’t see your jurisdiction on this list or if the program link instructs you to continue this application, thencontinue to A.4. below.A.4. Some tribes are operating their own rental assistance program. Tribal members are encouraged toapply through their tribal programs. The below list includes tribes operating a tribal specific program.If your tribe is not listed below, or if you are not a tribal member, you are eligible for the state programand should continue with this application.Tribe or Housing AuthorityPhoneTolowa Dee-ni' Nation(707) 487-9255Wilton Rancheria(916) 683-6000North Fork Rancheria Indian Housing Authority(559) 877-7360Resighini Rancheria(707) 482-2431Bear River Band of the Rohnerville Rancheria(707) 733-1900ext. 238Yurok Indian Housing Authority(707) 482-1506Susanville Indian Rancheria Housing Authority(530) 257-5033Kashia Band of Pomo Indians(707) 591-0580Enterprise Rancheria Indian Housing Authority(530) 532-9214ext. 106Redwood Valley Little River Band of Pomo Indians(707) 485-0361Scotts Valley Band of Pomo Indians(707) 263-4220Cedarville Rancheria(530) 233-3969Shingle Springs Rancheria(530) 698-1454Bridgeport Indian Colony(760) 932-7083Quechan Tribally Designated Housing Entity(760) 572-0243Santa Rosa Band of Cahuilla Indians(951) 659-2700Dry Creek Rancheria Band of Pomo Indians(707) 814-4150All Mission Indian Housing Authority(951) 760-7390Elem Indian Colony Sulphur Bank Rancheria(707) 542-6516Agua Caliente Band of Cahuilla Indians(760) 799-3502Pit River Tribe(530) 335-4809Robinson Rancheria of Pomo Indians of California(707) 275-0527Ramona Band of Cahuilla(951) 763-4105Ione Band of Miwok Indians(209) 245-5800Hoopa Valley Housing Authority(530) 625-4759Coyote Valley Band of Pomo Indians(707) 472-2207Campo Band of Mission Indians(619) 478-9046ext. 230Tule River Indian Housing Authority(559) 784-31557 of 44

For Assistance Call 1-833-687-0967Pala Band of Mission Indians(760) 891-3530Fort Bidwell Indian Community(530) 279-6310ext. 1Quartz Valley Indian Reservation(530) 468-5907ext. 313Chemehuevi Indian Tribe(760) 858-4219Bishop Paiute Tribe(760) 873-3584ext. 2310 or 2340Northern Circle Indian Housing Authority(707) 468-1336Big Valley Band of Pomo Indians(707)263-3924ext. 114San Pasqual Band of Mission Indians(760) 651-5130Greenville Rancheria(530) 284-7990Karuk Tribe Housing Authority (TDHE, Karuk Tribe)(800) 250-5811Pinoleville Pomo Nation(707) 463-1454Big Pine Paiute Tribe of the Owens Valley(760) 938-2003ext. 230 or 231Elk Valley Rancheria California(707) 464-4680Wiyot Tribe(707) 733-5055Picayune Rancheria of the Chukchansi Indians(559) 412-5590The Tejon Indian Tribe(661) 834-8566Modoc Lassen Indian Housing Authority(888) 257-5141Big Sandy Rancheria Band of Western Mono Indians(559) 374-0066ext. 226Mesa Grande Band of Mission Indians(760) 782-3818Timbisha Shoshone Tribe(760) 786-2374Round Valley Indian Housing Authority(707) 983-6188Lone Pine Paiute Shoshone Tribe(760) 876-1034Fort Independence Indian Community of Paiute Indian(760) 878-5151If you are not in a jurisdiction operating a local program, and if you are not a member of a tribe operating atribal program, you can complete the following application for assistance through the California COVID-19 RentRelief Program.8 of 44

For Assistance Call 1-833-687-0967B. Applicant InformationPlease enter the contact information below for the person(s) seeking rent and/or utility assistance (the personmust be on the lease/rental agreement). If you would like to designate someone to prepare the application onyour behalf, you can do so in this section.TENANT INFORMATIONB.1. Tenant First Name:B.2. Tenant Last NameB.3. Home Address: Please do not enter a PO Box. This should be the address for the unit where you arerequesting assistance.B.4. County: Please include the county where your unit is located9 of 44

For Assistance Call 1-833-687-0967B.5. Property Type: Select the type of unit that best represents your housing type. If you no longer live at theunit where you are requesting assistance, select “I no longer live at the unit”. Single-Family Home Duplex/Townhome Apartment Complex (0-10 units) Apartment Complex (11-50 units) Apartment Complex (50 units) Mobile HomeCheck all that apply for your Mobile Home I rent the unit from someone who owns the mobile home unit I rent the space in the park from the park ownerMotor HomeCheck all that apply for your Motor Home I rent the unit from someone who owns the motor home unit I rent the space in the park from the park owner Accessory Dwelling Unit (Granny Flat) Garage Conversion Bedroom in an apartment or home Hotel/Motel Unit Unhoused or Currently HomelessResources are available for you to locate local housing assistance. Please visit rr/ca continuum of care contacts.pdf for more information. I no longer live at the unit where I am requesting assistanceCheck the box below to acknowledge landlord participation requirements I recognize that in order to receive assistance for a unit where I no longer live, my landlord mustcomplete the landlord portion of the application process Other – Please provide the closest cross streets to your home10 of 44

For Assistance Call 1-833-687-0967B.6. Rental Agreement: Select the rental agreement type that best describes your unit. I have a rental agreement with the property owner or manager. This does not need to be a writtenlease. Any type of rental agreement is eligible, including an oral agreement. I am subleasing my unit from a tenant and I do not have a direct lease with the property owner.Note:we do not share your information with the property owner.B.7. Mailing Address: Complete if different from home addressB.8. Telephone Number()B.9. E-Mail: If you do not have a personal email account, you can work with your representative or one of thelocal partner agencies to get a free email address.B.10. Preferred method of communication: Let us know how you would like us to contact you. E-mail Phone MailB.11. Primary Language: What is your preferred language? English Spanish Chinese Korean Vietnamese Filipino Russian Portuguese11 of 44

For Assistance Call 1-833-687-0967B.12. Did you receive assistance from a member of a local partner network? If yes, please write in thename of the organization where you received help.B.13. Would you like to identify a representative to support you in completing your application?Representatives can request application status and can update your application on your behalf.Representatives must be added as new users in the View User link in the online application portal. Yes: I acknowledge that my representative will have access to all information provided in thisapplication, including my personal data and my uploaded documents. NoIf you would like to identify a representative, complete the following informationRepresentative NameRepresentative EmailRepresentative Phone number()B.14. How did you hear about us?12 of 44

For Assistance Call 1-833-687-0967C. COVID-19 ImpactC.1. Has anyone in the household experienced financial hardship due to the COVID-19 pandemic? Yes NoC.2. Please check the conditions that apply to anyone in your household related to the COVID-19pandemic (check all that apply): Currently unemployed for 90 days or more Laid off-Receiving unemployment assistance. Laid off-Not receiving unemployment assistance Place of employment has closed Reduction in hours of work Reduced Pay Reduction in Available Work Must stay home to care for child/children due to closure of daycare or school Are self-employed, and their business is no longer supplying them with income or such income hasbeen reduced. Incurred costs related to Stay-At-Home orders, work-from-home, or school-from-home requirementsincluding increased internet bills, increased utility bills, necessary equipment purchases, and otherunplanned costs Unwilling or unable to participate in their previous employment due to their high risk of severe illnessfrom COVID-19 Provided a financial distress form to landlord. Reduction or elimination of child or spousal support I or someone in my household had an unexpected COVID-19 related medical or funeral expense Child or Adult dependent care expenses increased due to COVID-19 If none of the above apply, please provide a description below of your or a household member'sfinancial hardship experienced due to the COVID-19 pandemic.13 of 44

For Assistance Call 1-833-687-0967 I attest that the above is true and correct to the best of my knowledge.Certifications andAttestations are legal statements that testify to the truth of your statements in this application.14 of 44

For Assistance Call 1-833-687-0967D. Rent Assistance RequestedComplete the amount that you owe for each month of housing payments due to your household’s COVID-19impact. Late fees/penalties are not eligible by law and should not be charged to households experiencingCOVID-19 related housing debt as per California Civil Code Section 1942.9. If you are requesting assistancefor rents (or if your utility is included as a part of the rent), please complete this section. If you are onlyrequesting utility assistance, you can skip this section.D.1. Are you requesting rental assistance? Yes NoD.2 Proof of Residency Signed lease agreement OR Current California State ID listing rental property address OR Official Third-Party documentation with name and property address (I.e. W-2, Paystubs) OR Government issued library card with applicant name and address OR Voter registration card with applicant name and address OR Utility/Bank/Credit Card statement with your name and address OR Other documents may be allowed on a case-by-case basisD.3. Monthly Rent Payment Amount: This is the amount you are supposed to pay each month according toyour rent agreement with you landlord D.4. Please input the amount of rent owed for each month. This is the amount of assistance you arerequesting for each month you need assistance.April 2020May 2020June 2020 July 2020August 2020September 2020 October 2020November 2020December 2020 15 of 41

For Assistance Call 1-833-687-0967January 2021February 2021March 2021 April 2021May 2021June 2021 July 2021August 2021September 2021 October 2021November 2021December 2021 January 2022February 2022March 2022 April 2022May 2022June 2022 July 2022August 2022September 2022 October 2022November 2022December 2022 Total Rent Assistance Requested (total of both arrears and current rents) D.5. Has your landlord issued a Notice to Pay, an Eviction Notice, filed an Unlawful Detainer againstyou due to unpaid rents, or indicated they will be seeking to evict you? Yes NoResources are available for tenants to locate self-help or to find legal aid services. Please visit for more information.In addition to visiting the link provided above with available resources for tenants to locate self-help groups orto find legal aid services directly, would you also like to be contacted by a free or low-cost local legal aid orself-help group for assistance if the ability to receive direct referral has been established in partnership with theState in your area?16 of 41

For Assistance Call 1-833-687-0967Please note, you are encouraged to utilize the resource provided above to locate organizations within yourarea upon submitting your application. Check the box below if you would like to potentially receive a referral. Yes, I consent to having my information shared with a local legal aid or self-help legal support group.LANDLORD INFORMATIONPlease select the contact information you can provide for your landlord or property manager. The morecontact information you can provide, the faster we will be able to process your application. You must provideat least one type of contact information otherwise we will not be able to process your application.D.6. Landlord or Property Management Entity NameD.7. Landlord Address: This is the address where you mail your rent checks if you mail your checks, or theaddress on your rent or lease agreement for your landlord or property manager.D.8. Landlord Phone Number: If you are not sure about your landlord’s phone number, include theemergency number you contact if something happens in your unit.()D.9. Landlord Email: Providing an email is the best way to ensure your application is processed as fast aspossible.D.10. Please Enter Landlord’s Case ID if known I attest that the information provided above is true and correct to the best of my knowledge andthat the costs identified in this request were incurred after April 1, 2020 as per California Law.17 of 41

For Assistance Call 1-833-687-0967E. Prior Assistance ReceivedAssistance provided under the COVID-19 RENT RELIEF Program for households economically impacted byCOVID-19 may not exceed a household's monthly unmet housing cost needs. List all other sources of rent orutility assistance received from local governments, the State, non-profit organizations, faith basedorganizations, or friends and family.PRIOR HOUSING ASSISTANCE RECEIVEDE.1. Have you or anyone in your household applied for, or received any rental and/or utility assistancefrom any source (local, state, federal, private) for the months you are applying for assistance?Examples are section 8 vouchers, rapid rehousing, homelessness prevention, Coronavirus rental assistance,subsistence assistance, local rent relief, and other programs intended to help with housing costs. If yes,proceed with this section. If no proceed to the next section. Previous assistance does not mean you areineligible for the California COVID-19 Rent Relief Program. Yes NoE.2. List the housing assistance you have already received each month, where applicable. List allsources of financial and/or housing assistance. Write in the source of assistance you received. Failure toinclude prior assistance received for every household member may prevent assistance from being providedOR you may be required to REPAY assistance later if you are found to be ineligible after assistance is granted.April 2020May 2020June 2020 Source:Source:Source:July 2020August 2020September 2020 Source:Source:Source:October 2020November 2020December 2020 Source:Source:Source:18 of 41

For Assistance Call 1-833-687-0967January 2021February 2021March 2021 Source:Source:Source:April 2021May 2021June 2021 Source:Source:Source:July 2021August 2021September 2021 Source:Source:Source:October 2021November 2021December 2021 Source:Source:Source:January 2022February 2022March 2022 Source:Source:Source:April 2022May 2022June 2022 Source:Source:Source:19 of 41

For Assistance Call 1-833-687-0967July 2022August 2022September 2022 Source:Source:Source:October 2022November 2022December 2022 Source:Source:Source: I attest that the information provided above is true and correct to the best of my knowledge.Please Sign and Date:SignatureDate20 of 41

For Assistance Call 1-833-687-0967F. Gas Utility AssistanceIf you are requesting Gas utility assistance, please complete the amount you are requesting by each monthbelow. Late fees or penalties should be entered in F.7. in the below table. If you are not requesting gas utilityassistance, please select “No” below. If you pay your utilities directly to your landlord, you do not need to fillthis section out.GAS/PROPANE UTILITY ASSISTANCE REQUESTEDIf your bill consolidates multiple utilities, you only need to enter the total once in one utility category. You donot need to break out the different utility costs by different utilities.F.1. Do you need help paying your gas bill, including missed payments? Yes, Complete this section No, You may skip to the next sectionF.2. If you are requesting gas/propane assistance, you must provide a copy of your most recentgas/propane utility statement to be uploaded into the online application. Gas/Propane Utility Statement *RequiredF.3. Gas/Propane Company NameF.4. Gas/Propane Company AddressF.5. Gas/Propane Account Number21 of 44

For Assistance Call 1-833-687-0967F.6. Gas/Propane Assistance RequestPlease input the amount of Gas assistance requested. If your bill only has the balance due and does notinclude monthly balances, you can put the full balance due in the month that matched the date on the bill, forexample, you can put the full amount on the March 2021 month for a bill received March 15, 2021.April 2020May 2020June 2020 July 2020August 2020September 2020 October 2020November 2020December 2020 January 2021February 2021March 2021 April 2021May 2021June 2021 July 2021August 2021September 2021 October 2021November 2021December 2021 January 2022February 2022March 2022 April 2022May 2022June 2022 July 2022August 2022September 2022 October 2022November 2022December 2022 22 of 44

For Assistance Call 1-833-687-0967F.14. Total Late Fees Requested Total Gas Utility Assistance Requested I attest that the information provided above is true and correct to the best of my knowledge andthat the costs identified in this request were incurred after April 1, 2020 as per California Law.23 of 44

For Assistance Call 1-833-687-0967G. Trash AssistanceIf you are requesting Trash utility assistance, please complete the amount you ar

For Assistance Call 1-833-687-0967 Program Overview CALIFORNIA COVID-19 RENT RELIEF PROGRAM What help is available? If you owe rent (“back rent” or “arrears”) we can help. If you cannot pay your rent now or are concerned about paying next month’s rent we can help. We can also help with

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1) A copy of the rent receipt, or rent statement showing the base rent paid prior to the rent increase notice, as stated in A.R.S. § 33-1476.04 (A), and a copy of the rent increas e notice. 2) A copy of the 90-Day Notice from the park showing the amount of rent increase as stated in A.R.S. § 33-1432 (F) and 33-1476.04 (A) and (B).

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