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Washington Wildfire Appliance Assistance Grants

The Washington Wildfire Appliance Assistance Grant is a disaster relief program for individuals and families affected by Washington wildfires between July 1, 2020 and June 30, 2021. The Washington State Legislature provided funds to the Washington Military Department to issue grants of up to $2,500 per eligible household for the purchase of household appliances. Grants will be awarded on a first-come, first-serve basis subject to availability of program funds. One application may be submitted per eligible household. 

“Household appliance” means a machine that assists with household functions such as cooking, cleaning and food preservation. 

Applicant's Name*

Applicant's Current Mailing Address - If awarded the grant, this is the address that the check will be mailed to.  This address may be different from the address of the home that was destroyed or damaged due to the wildfires.

Applicant's Current MAILING Address*

Applicant's Current Primary Residence Address

Applicant's Current PRIMARY RESIDENCE Address*
You can upload Proof of Identity, or take it in to your Disaster Case Manager to scan and upload for you. You can also email the file to ApplianceGrants@mil.wa.gov
No File Chosen
File uploads may not work on some mobile devices.

Identification  

(must show your name, date of birth, and photograph)

  • State identification card
  • Driver license
  • US passport or passport card
  • US military card (front and back)
  • Military dependent’s ID card (front and back)
  • Permanent Resident Card
  • Certificate of Citizenship
  • Certificate of Naturalization
  • Employment Authorization Document
  • Foreign passport

Eligibility Criteria Overview

To apply, an individual or family must meet ALL of the requirements below: 

1) Be a resident of Douglas, Okanogan, Pierce or Whitman County at the time of the fire (from July 1, 2020 through June 30, 2021);

2) Has suffered damage to their Primary Residence or were displaced from a rental unit used as their Primary Residence due to a wildfire occurring in fiscal year 2021 (July 1, 2020 through June 30, 2021);

3) Does not have or has inadequate private insurance to cover the cost of household appliance replacement;

4) Additionally, an individual or family must meet ONE of the following criteria:

A) Is disabled. The term “disability” or "disabled" means the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

B) Has a household income equal to or less than 80 percent of the County Median Household Income. Per RCW 84.36.383 "County Median Household Income" means the median household income estimates for the state of Washington by county of the legal address of the principal place of residence, as published by the office of financial management.

C) The home qualified for the Property Tax Exemption Program in RCW 84.36.379 through 84.36.389. The qualifying applicant receives a reduction in the amount of property taxes due. The amount of the reduction is based on the applicant's income, the value of the residence, and the local levy rates.

D) The home qualified for the Property Tax Deferral Program in chapter 84.38 RCW. Property Tax Deferrals must be repaid when the home is sold, the applicant passes away, or the home is no longer used as the primary residence. The Deferral Threshold is based on the County Median Household Income of the county where the residence is located.

Eligibility Criteria #1: Primary Residence

This grant is for applicants that have suffered damage to their Primary Residence due to a wildfire occurring in State Fiscal Year 2021.  To be eligible, the applicant must have suffered damage to their home or were displaced from a rental unit used as their Primary Residence due to a wildfire occurring from July 1, 2020 through June 30, 2021.

Primary Residence refers to:

  • The home where the applicant normally lives during the major portion of the calendar year, or
  • The home that is required because of proximity to employment, including agricultural activities that provide 50% of the household's income.
  • "Primary Residence" does NOT include vacation homes, hunting cabins, barns, other outbuildings or fencing. 

To be eligible, the applicant's destroyed or damaged primary residence must be in Douglas, Okanogan, Pierce, or Whitman County.

Date Your Home was Damaged/Destroyed? Date must fall within July 1, 2020 through June 30, 2021.*
Select one
Address of Destroyed or Damaged Primary Residence*
Are you currently a Washington State resident?*
You can upload Proof of Residency in the Damaged/Destroyed home at the time of the wildfire, or take it in to your Disaster Case Manager to scan and upload for you. You can also email the file to ApplianceGrants@mil.wa.gov
No File Chosen
File uploads may not work on some mobile devices.

Proof of Residency in the Damaged / Destroyed Home AT THE TIME OF THE WILDFIRE

(must show your name and the address of the damaged/destroyed residence at the time of the wildfire)

  • A utility bill which includes your name and address dated for the time period of the wildfire damage to your home
  • Electric bill from the time of the damage to the home
  • Water bill from the time of the damage to the home
  • Telephone bill from the time of the damage to the home
  • Tenancy agreement with your full name and all the information about how long you have lived in your current address
  • Gas bill from the time of the damage to the home
  • Garbage bill from the time of the damage to the home
  • Bank statement:  You can log into your account online to get a copy of the statement for the month that the damage occurred, or you can go to your bank and they will print out a copy of the statement for the month your home was damaged or destroyed. We only need the page of the statement that shows your name and address, we don’t need the whole statement. PLEASE BLACK OUT ANY ACCOUNT NUMBERS BEFORE SUBMITTING THIS DOC.

Eligibility Criteria #2: Description of Primary Residence Damaged or Destroyed by Wildfire

To be eligible, the applicant must have suffered damage to their home or was displaced from a rental unit used as their primary residence due to a wildfire occurring in fiscal year 2021 (July 1, 2020 through June 30, 2021).

Eligibility Criteria #3: Inadequate or No Insurance At The Time of the Wildfire

To be eligible, the applicant must have had NO insurance or had inadequate private insurance to cover the cost of household appliance replacement at the time of the fire.

IF YOUR PRIMARY RESIDENCE WAS A RENTAL THAT WAS DAMAGED OR DESTROYED

If you were a Renter and your home was damaged or destroyed by a wildfire, did the major appliances come with the rental? Was the refrigerator, stove, washer, and dryer already there when you moved in? Or did you put your OWN refrigerator, stove, washer, and dryer in the rental?   

In many instances, the major appliances (fridge, stove, washer/dryer, etc) are already in the rental, and the renter brings their own microwave oven, toaster oven and other small appliances.  If the major appliances were already in the rental, the Owner of the rental may file for those items.   

IF YOU WERE THE OWNER OF A RENTAL THAT WAS DAMAGED OR DESTROYED

If you were the owner of a rental that was someone else's Primary Residence and the kitchen, laundry or other approved appliances were provided by you (NOT owned by the Renter), then you may fill out an application for the Rental property for only the appliances that you provided as part of the rental.  If you provided the major appliances, the Renter is not allowed to claim them on their application.  

If your own Primary Residence got damaged or destroyed, then you may fill out a SEPARATE application for your own Primary Residence.

Did You Own or Rent Your Primary Residence at the Time of the Fire?*
What Type of Insurance Did You Have on Your Primary Residence at the Time of the Fire?*
Did your insurance company give you any money for the loss of property due to the wildfire?*

IF YOUR INSURANCE COMPANY GAVE YOU ANY MONEY TO REPLACE SOME OR ALL OF YOUR CONTENTS

If your insurance company gave you money to replace some or all of your contents, they would have sent you a letter itemizing the items they paid you for. This is referred to as a Letter of Insurance Settlement. We will need a copy of that letter showing the itemized list of things that they paid you for. You can upload the Letter of Insurance Settlement from your insurance company, or take it in to your Disaster Case Manager to scan and upload for you. 


REQUIRED:  BLACK OUT YOUR SOCIAL SECURITY NUMBER FROM TAX RETURNS, OR ACCOUNTING & ROUTING NUMBERS ON ANY DOCUMENTS YOU SUBMIT!!

~~~~~~~~~~~~~~~~~~~~~~

TACHAR U OSCURECER SU NÚMERO DE SEGURO SOCIAL, NÚMEROS DE CUENTA, DE RUTA Y TRANSITO EN CUALQUIER DOCUMENTO QUE PRESENTE

You can upload the Letter of Insurance Settlement from your insurance company that gives an itemized list of what they paid for, or take it in to your Disaster Case Manager to scan and upload for you. You can also email the file to ApplianceGrants@mil.wa.gov
No File Chosen
File uploads may not work on some mobile devices.

Additional Eligibility Criteria

An individual or family must meet ONE of the following criteria: 

A) Is disabled. The term “disability” or "disabled" means the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

B) Has a household income equal to or less than 80 percent of the County Median Household Income. Per RCW 84.36.383 "County Median Household Income" means the median household income estimates for the state of Washington by county of the legal address of the principal place of residence, as published by the office of financial management.

C) The home qualified for the Property Tax Exemption Program in RCW 84.36.379 through 84.36.389. The qualifying applicant receives a reduction in the amount of property taxes due. The amount of the reduction is based on the applicant's income, the value of the residence, and the local levy rates.

D) The home qualified for the Property Tax Deferral Program in chapter 84.38 RCW. Property Tax Deferrals must be repaid when the home is sold, the applicant passes away, or the home is no longer used as the primary residence. The Deferral Threshold is based on the County Median Household Income of the county where the residence is located.

A.  Disability

Do you have a disability as defined in RCW 84.36, which defines disability as the same meaning in 42 U.S.C. Sec. 423(d(1)(A) - (1) The term “disability” means— (A) inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

Do you have a Disability?*

Proof of Disability

Types of Proof of Disability include:

  • Written acknowledgement by Social Security
  • Written acknowledgement by the Veterans Administration
  • Proof of Disability Affidavit
  • Attestation from medical provider on facility letterhead 
  • Award letter or other verification notice from a Federal or State agency demonstrating applicant is approved for a disability benefits program or other assistance program as a result of a disability.


REQUIRED:  BLACK OUT YOUR SOCIAL SECURITY NUMBER FROM TAX RETURNS, OR ACCOUNTING & ROUTING NUMBERS ON ANY DOCUMENTS YOU SUBMIT!!

~~~~~~~~~~~~~~~~~~~

TACHAR U OSCURECER SU NÚMERO DE SEGURO SOCIAL, NÚMEROS DE CUENTA, DE RUTA Y TRANSITO EN CUALQUIER DOCUMENTO QUE PRESENTE

You can upload Proof of Disability (if disability is being used as a qualifying factor), or you can take it in to your Disaster Case Manager to scan and upload for you. You can also email the file to ApplianceGrants@mil.wa.gov
No File Chosen
File uploads may not work on some mobile devices.

Do you have a household income equal to or less than 80% of the County Median Household Income? 

Per RCW 84.36.383 (property tax exemption definitions), (3) "County Median Household Income" means the median household income estimates for the state of Washington by county of the legal address of the principal place of residence, as published by the office of financial management.”  The Office of Financial Management 2019 estimates are: 

Douglas County:

  • Median Household Income = $63,087
  • 80% Median Household Income* = $51,000  (so your income must be less than $51,000 to qualify in Douglas County)

Okanogan County:

  • Median Household Income = $44,028
  • 80% Median Household Income* = $36,000  (so your income must be less than $36,000 to qualify in Okanogan County)

Pierce County:

  • Median Household Income = $74,774
  • 80% Median Household Income* = $60,000  (so your income must be less than $60,000 to qualify in Pierce County)

Whitman County:

  • Median Household Income = $53,705
  • 80% Median Household Income* = $43,000 (so your income must be less than $43,000 to qualify in Whitman County)

*80% of the median household income rounded UP to the nearest $1,000.

Is Household Income equal to or less than 80% of the county median household income?*
$

Proof of income can include, but is not limited to:

  • Pay stubs covering the last 60 days of income
  • Social Security letter
  • Unemployment benefits letter
  • Letter attesting to being unemployed and receiving no income during State Fiscal Year 2021
  • W-2 forms or most recently filed tax statements demonstrating income.
  • Proof that the applicant’s income is below the minimum threshold to file a federal tax return based on their filing status.
  • Documentation of self-employment, if applicable

REQUIRED:  BLACK OUT YOUR SOCIAL SECURITY NUMBER FROM TAX RETURNS, OR ACCOUNTING & ROUTING NUMBERS ON ANY DOCUMENTS YOU SUBMIT!!

~~~~~~~~~~~~~~~~~~

TACHAR U OSCURECER SU NÚMERO DE SEGURO SOCIAL, NÚMEROS DE CUENTA, DE RUTA Y TRANSITO EN CUALQUIER DOCUMENTO QUE PRESENTE

You can upload Proof of Income, or take it in to your Disaster Case Manager to scan and upload for you. You can also email the file to ApplianceGrants@mil.wa.gov - REMEMBER TO BLACK OUT YOUR SOCIAL SECURITY NUMBER(S) OR BANK ACCT NUMBERS.
No File Chosen
File uploads may not work on some mobile devices.

C:  Property Tax Exemption Program Eligibility

D:  Property Tax Deferral Program Eligibility

List of Approved Appliances

This grant will cover the cost of the appliance, taxes, and shipping/delivery fee. Grant award amounts are based on each individual appliance. The Applicant must first use the funds for purchasing approved appliances. The Applicant may choose to purchase a more expensive approved appliance and forego the purchase of other major or minor appliances they were awarded for. For example, an applicant is awarded $1,265 for a refrigerator and $231 for a microwave for a total award of $1,496. The Applicant decides to purchase a refrigerator for $1,500, using all the grant money and some of their personal funds and does not have any remaining funds to purchase a microwave. The Applicant submits a receipt for the purchase of the refrigerator only.

Some appliances such as a gas stove, a cooking range hood or a microwave over the range may need to be installed by a professional. If the Applicant selects one of those items, immediately below each of those items is a box to check that sets aside, or allots, $100 for professional installation. That box should also be checked to help the applicant stay within the $2500 appliance allowance. If the applicant is not getting one of those appliances, then those boxes do not need to be checked.

In some cases, the residence (usually a rental) that was destroyed came with major appliances such as the refrigerator and range (and maybe a washer and dryer). If the Applicant is forced to move because the residence is no longer habitable, and if the new Primary Residence does NOT come with a refrigerator or stove (or washer and dryer), it is permissible for the Applicant to request a refrigerator and range even though they didn’t own either of those in the destroyed residence.

Once approved for the grant, copies of itemized receipts must be submitted to Washington Emergency Management Division within 120 days from the date the check is issued. All receipts must be clear and legible on every item the applicant is purchasing, including tax, shipping/delivery, and installation. Instructions on how to submit receipts will be in the Award Letter. 

WHAT IF THE APPLICANT PURCHASES AN APPLIANCE FOR LESS THAN THE AMOUNT GRANTED?

If the Applicant purchases an appliance for less than the amount granted, the remaining money can be used to purchase additional approved appliances. Those additional appliances must be from the Approved Appliance List on this application, otherwise the remaining money must be returned.

For example, if the Applicant checks the box to get a refrigerator, they will receive $1265 for a refrigerator (and that amount would have to include the cost of the refrigerator, taxes, and shipping/delivery). If the Applicant found a great deal on a refrigerator where the cost of the refrigerator, taxes and delivery were only $900, the Applicant could use the remaining $365 for one or more appliances on the Approved Appliance List.

For example, the Applicant could NOT use the remaining $365 for clothing, or a mini-vacation, or new tires, or a new phone. The Applicant would HAVE to submit a receipt or receipts showing that the $365 was spent on an approved appliance OR THEY WOULD HAVE TO REPAY THE $365. When in doubt, the Applicant should contact their disaster case manager for guidance.

PLEASE NOTE: Some appliances may need to be installed by a professional. You will want to allow for the installation costs as they will come from the $2500 maximum appliance allowance. You are not required to check the boxes that earmark $100 for professional installation. The boxes are there as a tool that may be helpful when deciding how to allot the $2500. 

The installation costs are NOT over and above the $2500.

Major Appliances (Maximum is $2500 for Major + Small Appliances)*
$
Small Appliances (Maximum is $2500 for Major + Small Appliances)
$
$

You have exceeded $2500.00 total. You will only be awarded for $2500 maximum. 

Household Members

Please list all adults who live in the applicant's household at the time of the fire, INCLUDING THE APPLICANT AND SPOUSE IF ANY.  Failure to list all adults may result in the denial of the grant application. List one person per line. 

Your Electronic Signature

Penalty Warning

  • I understand the questions on this application.
  • I understand that if I provide false answers, I may be criminally prosecuted for fraud and may be required to pay back the money I received. I certify, under penalty of perjury, that the information I give is correct and complete to the best of my knowledge.
  • I authorize the release of any information necessary to determine eligibility and to determine if I correctly received my benefits. I authorize the release of any information necessary to pursue collections of money for overpayment or if the money was not used in accordance with the rules of this program.
  • I certify that I have not received money from any organization, person, or insurance company for the same appliances for which this grant would fund.
  • I certify that I have listed all other adult members of my household and no other members of my household are applying for this grant. I understand multiple applications from the same household will result in a denial of my application.
  • I agree to submit copies of receipts for the appliances purchased with these grant funds to the Washington Military Department within 120 calendar days of the issue date on the check.
  • I understand that failure to timely submit copies of receipts for appliances purchased or to otherwise comply with the requirements for receiving this grant will result in the recoupment of the grant funds.
By signing my name below, and clicking the "Submit Form" button, I am agreeing to the terms listed above and agree to the terms of this program.*
Use your mouse or finger to draw your signature above
Today's date*
:  

PLEASE NOTE: You will receive a PDF copy of your application with your Confirmation Email.

If you do not receive the PDF of your application, it is because your internet provider labeled it suspicious and removed it. If that happens, you can contact your county Disaster Case Manager and request a copy of it.

This page intentionally blank. Please continue, and begin processing the 

Washington Wildfires Appliance Assistance Grants Application

County Disaster Case Managers Process New Applications

County Disaster Managers will receive the Washington Wildfire Appliance Assistance Applications from the individuals filling out the applications in their jurisdictions. The Disaster Case Managers (DCM's) will first and foremost check the date that the applicant entered as the date that the Primary Residence was damaged by the wildfire. The wildfire damage must have occurred during the period from July 1, 2020 through June 30, 2021 (the 2021 fiscal year).

IF the wildfire damage date falls within the correct date range, the Disaster Case Manager will proceed to process the application.

IF the wildfire damage date is outside of the correct date range, the application not able to be processed. The DCM will need to call the applicant for clarification. Was the date entered a typo? Or did the date fall outside of the approved window of time?

If the date entered was a typo, the case manager can correct the date and then continue the processing of the application.

If the date of the wildfire damage was actually outside of the approved date range the Disaster Case Manager must explain to the applicant that the application will have to be denied, and that they will receive a Letter of Denial due to the date of wildfire damage being outside of the approved dates.

Date Disaster Case Manager Received Application*
:  
Applicant's Name*
Date of damage to the applicant's Primary Residence at the time of the Fire*

Disaster Case Manager for Douglas and Okanogan Counties

Jessica Farmer, Lead Disaster Case Manager, OCLTRG

Phone (509) 846-5101

Email  OCLTRGresources@gmail.com 

Disaster Case Manager for Pierce County

Jim Cummings

Washington Emergency Management Division

Mobile: 253-345-0217

DisasterReservist.hsdr11@mil.wa.gov

Monday - Friday 9:00am - 4:30pm

Disaster Case Manager for Whitman County

Chandelle Frick 

Pine Creek Community Restoration Long Term Recovery Organization

Mobile: 509-939-6005

chandellef13@gmail.com

Does the date the wildfire damaged the Primary Residence fall into the Fiscal Year 2021 (July 1, 2020 to June 30, 2021)?*

If "YES, THE DATE OF DAMAGE DUE TO WILDFIRE" is within the approved date range (fiscal year 2021, 7/1/2020 - 630/2021), continue processing this application. Go to the next step of the Review "REQUIRED DOCUMENTATION."

If "NO, THE DATE IS NOT IN FISCAL YEAR 2021", call the Applicant to verify the Date of Damage due to wildfire: 

If the out of range date was a typo, change the damage date on the application (below) and continue processing the Application.

If the date was entered correctly, and the damage date is outside of the Fiscal Year 2021, mark application as Denied Due to 'Damage to Primary Residence outside of Fiscal Year 2021'. 

Result of phone call to the applicant

The date of damage to the Primary Residence was entered correctly, per the Applicant.

If the date that the wildfire damaged the Primary Residence falls outside of the Fiscal Year 2021 (July 1, 2020 - 6/30/2021), the application for appliance assistance must be denied. YOU are not denying the application. You are recommending that, based on the established criteria of the damage happening in the fiscal year 2021, that the damage occurred outside of that date range and you are recommending that the application be denied based on that fact. The application still continues on to the next step of the review process by WA State HS-EMD case processors. In the Status of Application field you would select from the dropdown list 'date of damage is outside of the fiscal year 2021'.  Once you click the Submit button, the application then goes on to the WA State HS-EMD case processors for further review.

The date of damage to the Primary Residence was entered incorrectly, per the Applicant.


If the out of range date was entered incorrectly, change the damage date on the application (in the field below) to the correct date, and continue processing.

Corrected Date of Wildfire Damage to the Primary Residence

Avoiding Duplication of Benefits on Appliances

In order to avoid Duplication of Benefits, which would require recoupment, this Appliance Grant can not award assistance for any appliance that shows up on the Insurance Company Settlement Letter. 

The list of appliances on this Appliance Assistance application must be double checked against the list of appliances paid for by the insurance company. IF THERE ARE any duplications (for example, a Refrigerator on the Insurance Settlement Letter AND on this application, this application will need to be amended.  The Disaster Case Manager will need to reach out to the Applicant for clarification on any appliances that are duplicates, and have them select other appliances. 

The Disaster Case Manager has the ability to edit the list of Major Appliances and Small Appliances. You will see that there is a field that auto populates giving you sub-totals and then towards the bottom of the Small Appliances, the grand total of selected appliances. Please check for duplication of benefits and amend the application as needed before submitting it for further processing.

One further note:  if the list of appliances comes up to $2497 (as an example) then that is the amount that should be put in the Total Amount Requested field, not $2500. 

Required documentation for the Appliance Assistance Grant

All applications must have the following documents:

  • Identification
  • Proof of Residency
  • Proof of Income

The following documentation is necessary only if they are basing any part of the application on this information:

  • Letter of Insurance Settlement showing the itemized list of what the insurance company paid for
  • Proof of Disability
Required Docs That Have Already Been Submitted to DCM/LTR (select all that apply)*
Required Documentation that is MISSING (select all that apply)

Missing Documentation 

If Required Documentation is missing, the County Disaster Case Manager should contact the Applicant and have the Applicant either email a digital copy of the document to the Disaster Case Manager, or bring in a hard copy that the Case Manager can scan. The County Disaster Case Manager has the ability to edit the application, and to upload documents. If there is a document that has already been uploaded by the applicant, you can easily replace that document by uploading the corrected one. The newly uploaded document REPLACES the one that was already there automatically. 

Example:  The 1040 Form has been uploaded by the Applicant as Proof of Income, however the Applicant did not black out the Social Security numbers. They MUST be blacked out (redacted). You request a 1040 Form from the Applicant that has the Social Security numbers blacked out. They email you a new version of the 1040 that does have the SS numbers blacked out. You'll have to save the file to your computer, then click the Select File button on the application, and select the redacted 1040 file. When you have finished processing the application, you'll select the Status of the application from the dropdown list then click Submit. What will happen is that the new redacted version of the 1040 form will have replaced the old one we didn't want.

If you have any problems/issues with this, you can call or email the HS-EMD Application Reviewer who should be able to answer any question or issue you run into. 

Teri Simpson, HS-EMD Application Reviewer
Email  HSDR4@mil.wa.gov
Phone  360-339-4329

Identification 

(must show your name, date of birth, and photograph)

  • State identification card
  • Driver license
  • US passport or passport card
  • US military card (front and back)
  • Military dependent’s ID card (front and back)
  • Permanent Resident Card
  • Certificate of Citizenship
  • Certificate of Naturalization
  • Employment Authorization Document
  • Foreign passport

Proof of living in the Damaged/Destroyed Residence AT THE TIME OF THE WILDFIRE

(must show your name and the address of the damaged/destroyed residence at the time of the wildfire)

  • A utility bill which includes your name and address dated for the time period of the wildfire damage to your home
  • Electric bill from the time of the damage to the home
  • Water bill from the time of the damage to the home
  • Telephone bill from the time of the damage to the home
  • Tenancy agreement with your full name and all the information about how long you have lived in your current address
  • Gas bill from the time of the damage to the home
  • Garbage bill from the time of the damage to the home
  • Bank statement:  You can log into your account online to get a copy of the statement for the month that the damage occurred, or you can go to your bank and they will print out a copy of the statement for the month your home was damaged or destroyed. We only need the first page of the statement, not the whole statement. PLEASE BLACK OUT ANY ACCOUNT NUMBERS BEFORE SUBMITTING THIS DOC.

Proof of Disability

Types of Proof of Disability include:

  • Written acknowledgement by Social Security
  • Written acknowledgement by the Veterans Administration
  • Proof of Disability Affidavit
  • Attestation from medical provider on facility letterhead 
  • Award letter or other verification notice from a Federal or State agency demonstrating applicant is approved for a disability benefits program or other assistance program as a result of a disability.

* BLACK OUT YOUR SOCIAL SECURITY NUMBER, ACCOUNTING AND ROUTING NUMBERS ON ANY DOCUMENTS YOU SUBMIT *

Proof of Income   

(must show your name, and it is REQUIRED that you black out all Social Security numbers, or account / routing numbers)

Proof of income can include, but is not limited to:

  • Pay stubs covering the last 60 days of income
  • Social Security letter
  • Unemployment benefits letter
  • Letter attesting to being unemployed and receiving no income during State Fiscal Year 2021
  • W-2 forms or most recently filed tax statements demonstrating income. 
  • Proof that the applicant’s income is below the minimum threshold to file a federal tax return based on their filing status.
  • Documentation of self-employment, if applicable

Additional Supporting Documentation Upload Plus Comments Area

Below are 4 upload boxes for any additional documents that support the applicant and the application for this grant. Use the Comments box immediately below the upload fields for comments on the uploads or for comments on site / damaged property visits or interactions that support this application.


ATTENTION DISASTER CASE MANAGERS:

If you received a paper application from the applicant and you created the electronic version, please upload a copy of the paper application so that there is an actual signature from the applicant on file. Thank you.

File Upload for additional supporting documentation
No File Chosen
File uploads may not work on some mobile devices.
File Upload for additional supporting documentation
No File Chosen
File uploads may not work on some mobile devices.
File Upload for additional supporting documentation
No File Chosen
File uploads may not work on some mobile devices.
File Upload for additional supporting documentation
No File Chosen
File uploads may not work on some mobile devices.
Upload Identification
No File Chosen
File uploads may not work on some mobile devices.
Upload Proof of Residency
No File Chosen
File uploads may not work on some mobile devices.
Upload Proof of Income
No File Chosen
File uploads may not work on some mobile devices.
Upload Proof of Disability
No File Chosen
File uploads may not work on some mobile devices.
Upload Letter from Insurance Company itemizing what they paid for.
No File Chosen
File uploads may not work on some mobile devices.

Application Status

The NOTES area is there for you to enter notes while working on the application before it is ready to be Submitted. Some use examples:

9/14 left message for Bob to call me

9/15 returned application to Becky so she can dedact 1040 form and then return

Once you have all the required documentation, and AFTER you have verified that the damage to the primary residence was caused by wildfire, and that it did happen in fiscal year 2021 (July 1, 2020 to June 30, 2021), then you are ready to select the appropriate Status from the dropdown. These are the 4 selections for the Status dropdown list:

  • Application & Required docs complete – Application is recommended for further processing by WA State HS-EMD per DCM
  • Recommend denial - wildfire damage to Primary Res was not in Fiscal Year 2021
  • Recommend denial – household income too high
  • Recommend denial – see Notes
The county Disaster Case Manager verified that the residence in this application was destroyed by wildfire during Fiscal Year 2021.*
Date*
:  

HS-EMD Application Packet Review

HS-EMD receives the application and required support documentation from the county Disaster Case Manager, who has recommended to continue processing the application, or denying the application based on one or more criteria not being met. 

The HS-EMD Application Processors will

  • Verify that all Eligibility Requirements are met by reviewing the submitted appliance assistance grant application and the supporting documentation
  • Recommend that the application be Approved, Denied or Needs further documentation
  • Recommend the amount that should be awarded to the applicant
  • Generates an A-19 form and uploads it to this step of the process, as well as sends it as an email attachment to Travis for final approval
Date*
:  
Current Primary Residence is in Washington State?*
Copy of Proof of Indentity is attached/uploaded? (Drivers License, etc)*
DATE Primary Residence was damaged by wildfire was in Fiscal Year 2021? (July 1, 2020 - June 30, 2021)*
COUNTY of Primary Residence was Douglas, Okanogan, Pierce or Whitman?*
Proof of Residency has been attached/uploaded?*
Damage to Primary Residence was caused by wildfire (not flood, wind, snow, etc)?*
Type of Insurance on Primary Residence that was Damaged in the Wildfire*
Did the applicant get any money from their insurance company?*
Is a copy of the Settlement Letter from the insurance company attached/uploaded?*

Avoiding Duplication of Benefits on Appliances

In order to avoid Duplication of Benefits, which would require recoupment, this Appliance Grant can not award assistance for any appliance that also shows up on the Insurance Company Settlement Letter. 

The list of appliances on this Appliance Assistance application must be double checked against the list of appliances paid for by the insurance company. IF THERE ARE any duplications (for example, a Refrigerator on the Insurance Settlement Letter AND on this application), this application will need to be amended.  

BOTH THE COUNTY DISASTER CASE MANAGERS AND THE HS-EMD APPLICATION PROCESSORS ARE ABLE TO EDIT THE LIST OF APPLIANCES ON AN APPLICATION (but no other data). 

If there are duplications regarding appliances on this application and the Insurance Settlement Letter, the application can be returned to the DCM so that they can reach out to the Applicant and make necessary changes to the requested appliances so there are no duplications, therefore no Duplication of Benefits or recoupments.

Once the DCM has amended the application, they can resubmit it to the HS-EMD Application Processors.

Are there ANY appliances selected on this application that are ALSO listed on the Insurance Settlement Letter?*

If there ARE any appliances on both this application and the Settlement Letter from the insurance company, you can route the application back to the appropriate county DCM to correct, and then return to you. 

Is the applicant disabled?*
Has Proof of Disability been attached/uploaded?*
$
Has Proof of Income been attached/uploaded?*

Proof of income can include, but is not limited to:

  • Pay stubs covering the last 60 days of income
  • Social Security letter
  • Unemployment benefits letter
  • Letter attesting to being unemployed and receiving no income during State Fiscal Year 2021
  • W-2 forms or most recently filed tax statements demonstrating income. 
  • Proof that the applicant’s income is below the minimum threshold to file a federal tax return based on their filing status.
  • Documentation of self-employment, if applicable
Did the applicant have a household income EQUAL TO OR LESS THAN 80% of the County Median Household Income? *

Median Household Incomes

  • Douglas County: 80% Median Household Income* = $51,000
  • Okanogan County: 80% Median Household Income* = $36,000
  • Pierce County: 80% Median Household Income* = $60,000
  • Whitman County: 80% Median Household Income* = $43,000
#1 Have Eligibility Requirements been met for an Appliance Assistance Grant for this applicant?*
#2 Do I recommend that this applicant be approved for an Appliance Assistance Grant?*
$
Is the recommended Award Amount equal to the Total Requested Amount (which is the total of the selected appliances)?
Have you filled out a Form A-19 for this applicant?*
Upload the Form A-19 file with an approved Standardized File Name.*
No File Chosen
File uploads may not work on some mobile devices.

Go fill out the A-19 then save it with the Standardized File Name. Then upload the A-19 PDF. (Please read How to Give the A-19 form a Standardized File Name.)

HOW TO GIVE THE A-19 FILE A STANDARDIZED FILE NAME

Before you can send the completed Application Packet to Travis, you have to fill out an A-19 form for him to approve and send to Finance. The form is an Excel doc, and once filled out, you will need to save it as a PDF file.  You don't need to upload this file, you will email it to Travis right after you submit this step of the Workflow. 

HOW TO NAME THE A-19 FILE AND WHERE TO SAVE IT TO:  (where to save it to needs to be defined as Jim and Teri can not access the Share drive.)

As for the Standardized Name of the File, we will use this format until we hear otherwise:

For example, on a file for the applicant Paul Huethenstahler who is from Okanogan county, and whose application has the unique Submission ID number "Submission ID: 853290776", we would configure the file name like this:

We would put the County first so if we ever wanted to do an alpha sort to pull up all Pierce county applicants we could.  "Okanogan

Then we would put the applicant's last name then first name - why both? why not just the last name?   "Okanogon Huethenstahler Paul

#1 - because if the applicant submitted TWO applications it would be INSTANTLY OBVIOUS when we saved this file.  And 

#2 - Why don't we use ONLY the last name? Because in small rural towns there can be 3 generations of one family living there, and there can be many households of siblings and grandkids: Johan Huethenstahler homesteaded in Omak in 1935. He had 12 children (8 boys plus an unmarried daughter, then some married daughters). So in Omak (still "as an example"), there is the potential of 8 households all with the last name of Huethenstahler. Having that first name in the file name can save a lot of time when we are looking for Paul Huethenstahler. 

Next we put the unique Submission ID number.  This is the unique Application number that is assigned to the application when originally submitted, and which will travel with this application throughout all steps and phases. And then lastly, the date that the application was submitted by the applicant. So now we have 'Okanogan Huethenstahler Paul 853290776 09-01-2021 A-19 for appliance grant.xlsx'.


These File Upload fields are for additional documentation that may be needed for this application. Give a brief description of what the uploaded files are for in the Comments field below the Upload boxes. If possible, have the application ID # and applicants name in the file name.

File Upload for support documents that may be needed for this application.
No File Chosen
File uploads may not work on some mobile devices.
File Upload for support documents that may be needed for this application.
No File Chosen
File uploads may not work on some mobile devices.
File Upload for support documents that may be needed for this application.
No File Chosen
File uploads may not work on some mobile devices.
File Upload for support documents that may be needed for this application.
No File Chosen
File uploads may not work on some mobile devices.
HS-EMD Reviewer Recommends*

Time to hit the Submit Form button and send the Application Packet to the Grants Coordinator.

  • Human Services Program Supervisor Reviews the 
  • WA Wildfire Appliance Assistance Grants Application Packet for Final Approval


Lisa Barbier or Taylor Hennessee receives the Washington Wildfire Appliance Assistance Grant application packet from the HS-EMD Application Processors, which will have their recommendation on approving or denying the application. If they are recommending the application be approved, they will also recommend the amount of the award. As part of the application packet, they will also be sending a completed Form A-19 for final approval by Travis, before he submits it to the Finance Office.

Upon review, the application is:*
Upon review, the Form A-19 is:*
$

FINAL APPROVAL OF THE WASHINGTON WILDFIRE APPLIANCE ASSISTANCE GRANTS APPLICATION PACKET


Final Approval of the Appliance Assistance Grant Application is done by Lisa Barbier or Taylor Hennessee, Human Services Program Supervisor.  In the event that Lisa Barbier or Taylor Hennessee is unavailable to give Final Approval on the application packet, the application packet will be approved (or denied) by Quinn Butler, Recovery Planning Program Manager, Emergency Management Division.

FINAL APPROVAL GIVEN BY:*
FINAL APPROVAL DATE/TIME*
: :
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