General Assistance Application printable pdf download

JACKSON COUNTY GENERAL ASSISTANCE

Jackson County Courthouse

Terry Creegan, Director

Debbie Schroeder, Assistant

201 West Platt Street

Phone: 563-652-0070

Maquoketa, IA 52060

Email:

generalrelief@co.jackson.ia.us

GENERAL ASSISTANCE APPLICATION

READ THIS FIRST!

To apply for Jackson County General Assistance:

1. Fill out the application.

2. Gather all the items listed below.

3. Call the Office to schedule an intake.

4. Bring the completed application and ALL the items on the list to the intake.

5. The Intake Officer will determine if the application is complete and can be accepted.

If you don’t bring ALL the items listed below, no assistance can be given!

Once an application is accepted, the Intake Officer will schedule an interview with the General Assistance

Director or other approving official. General Assistance office hours are Monday – Friday, 8:30 am to noon.

When the approving official determines that an application is complete, a decision will be made within ten (10)

working days.

ALL ITEMS ARE REQUIRED FOR EVERYONE LIVING IN THE HOME.

1. Application – fill in all blanks.

2. Identification – Driver’s License or Social Security card for everyone living in the home.

3. If all adults are not employed full-time, provide proof of their registration at Iowa Workforce

Development (formerly Job Service). This is not required if they are elderly, disabled, or the primary

caregiver of a child under six (6) years of age. (Ask for these forms.)

4. Proof of all income for the last 8 weeks (last 6 mos. for self-employment) for everyone living in the

home:

a) Paystubs or a signed statement from employer verifying gross and net wages, including pay-dates.

b) Self-employment records for last 6 months.

c) Proof of Unemployment Compensation benefits.

d) Proof of disability or pension benefits.

e) Personal Income Record from any other work.

f) Any other source of income.

5. Federal and State Income Tax Returns for last year for everyone living in the home.

6. SSI or Social Security verification for everyone living in the home, showing:

- Monthly benefits, or

- “Receipt Letter” showing when you applied and/or

- A letter denying benefits

See back of page! Page 1 of 8

General Assistance Application