HomeMy WebLinkAboutBack-Up DocumentsElderly Assistance Relief Fund I Guidelines and Application
Manolo Reyes, City of Miami Commissioner for District 4, is committed to improving the quality of life for all the
residents he serves. Neighborhoods in the District include Auburndale, Coral Gate, Englewood, Flagami, Golden
Pines, La Pastorita, Shenandoah and Silver sluff. His priorities focus an better transportation to connect residents
in the city and beyond, growth of our technology-based economy to create more jobs and international business
opportunities with Latin America, and reducing crime so residents feel safe in their communities.
The Commissioner's priorities also include tackling poverty and assisting the most vulnerable residents. To that end,
he is pleased to continue the partnership with The Miami Foundation to preserve the Elderly Assistance Relief Fund.
The Fund's Purpose
Commissioner Reyes knows that elderly residents often lack services and assistance and are unable to meet even
their basic needs. Through this Fund, he hopes to help them through hard times and maintain their quality of life.
The Miami Foundation (Fund Administrator)
Established in 1967, The Miami Foundation uses civic leadership, community investment and philanthropy to
improve the quality of life for everyone who calls Greater Miami home. We partner with individuals, families and
corporations who have created more than 1,000 personalized, philanthropic Funds. Thanks to them we've awarded
over $200 million in grants and manage nearly $280 million in assets to build a better Miami.
Eligibility for Assistance
The program is open to individuals who meet these criteria:
65 years of age or older
■ Live in the City of Miami District 4 (see the map)
■ Household income at/below City of Miami's Community Development Low Income Limits (80% of median):
Household Size 1 2 3 4 5 6
At or Below 80% $39,800 $45,450 $51,150 $56,800 $61,350 $65,900 $70,454 $75,000
■ Currently face added hardship and the assistance would help them manage and maintain their quality of life
Amount and use of assistance
An Applicant may receive up to $500 in support once per calendar year. The assistance can be used to pay for
expenses directly related to their hardship or for basic needs or services they could otherwise not afford.
Application and review process
■ Applications will be accepted at any time until all funds have been spent.
• The Miami Foundation will only consider complete applications.
■ Miami Foundation staff may request additional information beyond this application.
Where to Send Applications
Elderly Assistance Relief Fund
Office of Commissioner Manolo Reyes, District 4
3500 Pan American Drive I Miami, Florida 33133
For questions contact: David Garcia, City of Miami District 4 Aide to Commissioner i Phone: 305-250-5420
The City of Miami disclaims any responsibility or liability for the form and content of any information submitted
by Applicants. The City of Miami will not verify, affirm, make any representation or in any manner be responsible
for the content and submission of applications, or the decision to process or not process, as applicable, any
Elderly Assistance Relief Fund (Revised July 2017) 1 Page 1 of 3
application for funding under this program. Additionally, the City of Miami is not responsible or liable for the use,
or monitoring thereof, of any funds awarded through the program.
Elderly Assistance Relief Fund Application Date of Application
APPLICANT'S INFORMATION
Last Name:
Monthly Amount
First Name:
Applicant's Income:
Middle Name(s):
$
Date of Birth:
$
Age:
Weatherization Assistance Program (WAP)
Address - Street,
Apt. #
Address - City,
State, Zip Code:
Phone Number:
INCOME INFORMATION: Income includes all sources earned and assistance received: Job wages and self-
employment income; Government benefits such as SSI (Supplemental Security Income), TANF (Temporary
Assistance for Needy Families), (SNAP) Supplemental Nutrition Assistance Program, unemployment compensation;
also pensions, interest in savings and financial gifts regularly received.
The Applicant
Monthly Amount
Annual Amount
Applicant's Income:
$
$
Applicant's Expenses:
$
❑ Yes El No
The Household
Monthly Amount
Annual Amount
Total Household Income:
$
Temporary Assistance for Needy Families (TANF)
Total Household Expenses:
$
❑ Yes El No
How many people reside in the household, including the Applicant?
Does anyone in the household currently receive assistance from the following programs?
❑ Yes ❑ No
Supplemental Security Income (SSI)
❑ Yes ❑ No
Supplemental Nutrition Assistance Program (SNAP)
❑ Yes ❑ No
Temporary Assistance for Needy Families (TANF)
❑ Yes ❑ No
Community Services Block Grant (CSBG)
❑ Yes El No
Weatherization Assistance Program (WAP)
C7 Other(s) Tel/ us what program(s):
Elderly Assistance Relief Fund (Revised July 2017 f Page 2 of 3
Elderly Assistance Relief Fund Application Last Name:
APPLICANT'S LIVING SITUATION: Help us understand your current living situation.
Please check all that apply:
❑ The Applicant's income is the main income for the household
❑ The Applicant lives alone and has a caregiver who comes in to help them
❑ The Applicant lives with someone who is his/her primary caregiver
❑ There are children (age 18 or younger) who live in the household
❑ Someone in the household has a disability
Please check the one that best states the Applicant's housing situation:
❑ Lives in a home he/she owns and pays all or part of a mortgage
❑ Rents his/her home with no government subsidy for rental assistance
❑ Lives in a government -subsidized public housing development or Section 8 housing
• Lives in a nursing home, adult group home, dormitory, or other kind of group, assisted living facility
❑ Other situation:
STATEMENT OF HARDSHIP $ HOW ASSISTANCE FUNDS WILL BE USED: Please briefly tell us:
• Why are you applying and what basic needs or quality of life services do you need help to pay?
■ Has there been some change or crisis that made your financial or living situation worse?
■ How would you use assistance from the Fund and would it help ease or resolve your current situation?
ATTACHMENTS: Include a copy of the following documents: Check to show you attached them
❑ Drivers License or other Id that verifies your identity and your address
❑ A recent Pay Stub from your job, SSI, check, or other document that verifies income you listed
CERTIFICATION:
I certify that all of the information above is to the best of my knowledge and belief true, correct and complete. If
approved, I certify I will only use the funds for the purpose stated in this application and that I will provide The Miami
Foundation with documentation upon request I am also aware The Miami Foundation has the final decision on
approvals and denials and that the program does not include any appeals process.
Applicant's S�gnature. -
Cate;
The City of Miami disclaims any responsibility or liability for the form and content of any information submitted
by Applicants. The City of Miami will not verify, affirm, make any representation or in any manner be responsible
for the content and submission of applications, or the decision to process or not process, as applicable, any
application for funding under this program. Additionally, the City of Miami is not responsible or liable for the use,
or monitoring thereof, of any funds awarded through the program.
Elderly Assistance Relief Fund (Revised July 2017 1 Page 3 of 3