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RESIDENTIAL (HOUSEHOLD) CUSTOMER INTAKE FORM - COVID-19 UTILITY ASSISTANCE FUNDS PROGRAM

  1. RESIDENTIAL (HOUSEHOLD) CUSTOMER INTAKE FORM - COVID-19 UTILITY ASSISTANCE FUNDS

    On December 7, 2020, Spotsylvania County Utilities received award notification of $762,991.62 in CARES Act funds to assist with municipal utility customer relief. These funds allow the County to extend the offer of the COVID-19 Utilities Assistance Fund (COVD19 UAF) Program, through which customers may apply for bill assistance for those accounts unpaid between March 1, 2020, and June 30, 2021. Customers who receive water/sewer bills from Spotsylvania County, whose accounts are in arrears, and meet specified eligibility criteria, must submit an application for consideration. Customers will need to attest to experiencing economic hardship due to the COVID-19 pandemic as part of the application process. Applications must be received by August 15, 2021, and applications meeting criteria will receive a direct assistance payment reflected within the next billing period. Federal and State eligibility requirements apply. The applicant's certification of the submitted request for CARES Utility Assistance Funds will be kept on file for Federal and State auditing purposes.

  2. XXXXXX - XXXXXX (12-Digit Water/Sewer Account Number)

  3. Applicable Cause of Economic Hardship due to the COVID-19 pandemic:*

    Place a mark beside the applicable cause of economic hardship if you or a person in your household has experienced a loss of income due to the COVID-19 pandemic (check all that apply):

  4. Please note: You are only eligible for the COVID-19 Utility Fund Assistance if your cause of economic hardship is due to the COVID-19 pandemic. Any other reasons will not qualify.

  5. APPLICANT CERTIFICATION:
    The Residential Applicant must certify the information below by placing a mark in EACH box.
  6. Please check each box to certify that you understand the following:*

    This CARES Act Application will:

  7. Applicant's Certification:*
    Please check each box to certify the following:
  8. I am the account holder and have the authority to make this request. Further, I acknowledge the conditions listed above.*
  9. Spotsylvania County Utilities Customer Service:

    If you have questions or need assistance with this form, we are here to help. Please call or email Customer Service at:  

  10. Call: 540-507-7300, Option 1.

    Monday - Friday, 8:00 a.m. - 4:30 p.m.

  11. Email:
  12. Screener's Initials, Notes, Date, and Action Taken
  13. Leave This Blank:

  14. This field is not part of the form submission.