Title 1. Government and Finances – Chapter 125

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Community Support Fund

Rule Nos. 1 through 18

I. Purpose, Delegation, Adoption, Amendment and Repeal

1-1. Purpose. The purpose of the Community Support Fund rules is to provide guidance on how

the Community Support Fund is utilized so that the Nation can assist the greatest number of

members of the Nation who apply for assistance to the Fund in times of a catastrophic event,

catastrophic illness or injury, or emergency event when no other resources for assistance exist.

1-2. Authority. The Community Support Fund Law, Chapter 125, delegates rulemaking authority

to the Fund Operator pursuant to the Administrative Rulemaking law (Chapter 106 Oneida Code

of Laws).

1-3. These rules were adopted by the Economic Support Department of the Social Services Area

of the Government Services Division in accordance with the procedures of the Administrative

Rulemaking law.

1-4. These rules may be amended or repealed by the Economic Support Department and/or the

Oneida Business Committee pursuant to the procedures set out in the Administrative Rulemaking

Law. For the purpose of future amendments to these rules, each article is a separate rule and may

be amended as such.

1-5. Should a provision of these rules or the application thereof to any person or circumstances be

held as invalid, such invalidity shall not affect other provisions of these rules which are considered

to have legal force without the invalid portions.

1-6. In the event of a conflict between a provision of these rules and a provision of another rule,

internal policy, procedure, or other regulation; the provisions of these rules shall control.

1-7. These rules supersede all prior rules, regulations, internal policies or other requirements

relating to the Community Support Fund.

1-8. This Article applies to each subsequent rule listed herein.

II. Definitions

2-1. This section shall govern the definitions of words and phrases used within this rule. All

words not defined herein shall be used in their ordinary and everyday sense.

(a) “Applicant” means the subject of the application for assistance.

(b) “Business day” means Monday through Friday from 8:00 a.m. to 4:30 p.m., excluding

holidays of the Nation.

member that is in need of twenty-four (24) hour per day, seven (7) days a week care.

(d) “Case manager” means an employee within the Fund operator responsible for

administering Fund benefits.

(e) “Catastrophic event” means a natural or man-made incident, which results in a

substantial damage or loss requiring major financial resources to repair or recover.

Including, but is not limited to, a house fire, tornado, flood, or other disaster.

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(f) “Catastrophic illness/injury” means a serious debilitating illness, injury, impairment,

or mental or physical condition that involves:

(1) In-patient care;

(2) A period of continuing treatment due to a chronic serious health condition,

including, but not limited to, chemotherapy, radiation, dialysis, and daily or weekly

therapy resulting from trauma;

(3) A period of illness or injury that is long-term due to a condition for which

treatment may be ineffective including, but not limited to, stroke or terminal disease

or;

(4) Multiple treatments either for restorative surgery after an accident or other

injury, or for a chronic condition, including, but not limited tocancer or kidney

disease.

(g) “COBRA” means the Consolidated Omnibus Budget Reconciliation Act of 1985 also

known as continued group health care coverage costs under an employer’s plan.

(h) “Cosmetic” means any medical service provided with the intent to enhance a person’s

appearance, including, but not limited to, braces, veneers, teeth whitening, implants, or

other plastic surgery.

(i) “Critical Medical” means professionally delivered care or treating a life threatening

illness which requires immediate or regularly scheduled monitored medical care, which

includes, but is not limited to dialysis, chemotherapy, radiation, daily/weekly therapy

resulting from trauma. This does not include routine annual or semi-annual appointments.

(j) “Emergency event” means a situation that poses an immediate risk to health, life,

safety, property or environment. Emergencies require urgent intervention to prevent further

illness, injury, death, or other worsening of the situation.

(k) “Emergency medical travel” means an unexpected serious health situation or

occurrence requiring the immediate presence of immediate family. This includes, but is not

limited to, end of life situations, and/or an immediate family member is placed on life

support.

(l) “Eviction” means the legal notice received from a landlord or mortgage holder that

orders the tenant(s) to vacate the property.

(m) “”FMLA” means the Family Medical Leave Act, a Federal law authorizing temporary

time off from an employment position to provide direct care to a family member, without

losing their employment status.

(n) “Fund” means the Community Support Fund.

(o) “Fund Operator” means the Economic Support Department, or other area within the

Governmnetal Services Division designated authority over the operation of the Fund.

(p) “Garnishment” means a legal action that directs that money owed be seized to satisfy

a debt.

(q) “Household” means all persons who reside together at the same residence.

(r) “Immediate family” means an applicant’s husband, wife, mother, father, son,

daughter, brother, sister, grandparent, grandchild, aunt, uncle, niece, nephew, cousin, and

any of these relations attained through marriage or legal adoption, as well as a person who

has legal responsibility for the applicant, or a person the applicant has legal responsibility

of.

(s) “Incapacitation” means a state in which a person is temporarily or permanently

impaired by mental and/or physical deficiency, disability, illness or injury.

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(t) “Income” means a measurement including, but not limited to, a combination of

salaries, wages, retirement pension, disability income, government benefits, and

unemployment of all people sharing a particular household/residence.

(u) “Legal guardian” means a person who has the legal authority to care for the personal

and property interests of another person granted through a Court order.

(v) “Legal responsibility” means specific duties imposed upon a person to care or provide

for another including liability for personal obligations as granted through a Power of

Attorney or Court order.

(w) “Major medical surgery” means a surgical procedure that carries a degree of risk to

the patient’s life, or the potential for severe disability if something goes wrong during

surgery. It is a surgical procedure that usually requires a patient to be put under general

anesthesia and given respiratory assistance because he or she cannot breathe independently.

(x) “Nation” means the Oneida Nation.

(y) “Public health emergency” means the occurrence or imminent threat of an illness or

health condition which:

(1) is a quarantinable disease, or is believed to be caused by bioterrorism or a

biological agent; and

(2) poses a high probability of any of the following:

(A) a large number of deaths or serious or long-term disability among

humans; or

(B) widespread exposure to a biological, chemical, or radiological agent

that creates a significant risk of substantial future harm to a large number

of people.

(z) “Non-medical” means necessary intervention to support a patient with an on-going

medical illness, injury or potential life threatening illness, and requires further testing or

consultation with a specialist.

(aa) “Reimbursement” means to make repayment for expense(s) or a loss that incurred.

(bb) “Routine Exam” means an annual or semi-annual health exam provided by a

physician, dentist, orthodontist, oral surgeon, or other similar health care specialist.

(cc) “Security Deposit” means the payment of money held by a landlord in trust to protect

him/herself from unpaid rent or damage to the living space.

(dd) “Wages” means taxable income reported to the Internal Revenue Service for

performing work.

III. SHELTER ASSISTANCE

3-1. Purpose. The purpose of shelter assistance is to assist enrolled members of the Nation with

financial support for shelter expenses due to experiencing a catastrophic event, illness, or

injury where no other resources exist.

3-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

3-3. Eligibility Criteria. In order to be eligible for shelter assistance a person must provide a

completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(b) Documentation verifying catastrophic event, illness, injury or other emergency event

within the last thirty (30) days, including but not limited to:

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3-4.

3-5.

3-6.

(1) Medical verification specifying dates effected by illness or injury;

(2) Verification of short and/or long term disability specifying the dates received

and the amount of the benefit;

(3) Other documentation listing damage or loss.

from the applicant’s mortgage holder stating the applicant’s monthly mortgage payment

and current status;

(d) A current utility bill, such as a water, heat, or electricity bill;

(e) Verification of any mortgage disability insurance;

(f) Verification of an applicant’s personal and/or vacation time from employment; and

(g) Any other documentation requested by the Community Support Fund case manager.

Receipt of Required Documentation. Upon receipt of the completed application for shelter

assistance, the case manager shall determine if all required documentation was received from

the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant within five (5) business days in writing of

any necessary documentation that was not received and is still needed.

the case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for shelter assistance shall be valid for thirty (30) days. If the applicant

has a determination of award and/or coverage pending with another support or assistance

resource, the application will be valid for an additional fifteen (15) days upon proof of that

such determination is pending. If the applicant fails to provide all requested documentation,

the case manager shall send the applicant an expiration notice for their application.

Rent or Mortgage Assistance. An applicant may request assistance for rent or mortgage

payments.

(a) The amount provided for rent or mortgage assistance shall not exceed five hundred

dollars ($500.00) per month. The amount of rent or mortgage assistance shall not exceed a

total of twenty-four (24) months per life-time of the applicant.

(b) Only the applicant’s portion of the rent or mortgage owed shall be considered when

determining the amount of rent or mortgage assistance if the applicant’s household consists

of other adults.

applicant. Only a valid landlord or mortgage holder shall be paid.

Utility Assistance. An applicant may request assistance for utilities, such as heat, water, and

electricity.

(a) The utility bill shall be in the applicant’s or current household’s member’s name.

(b) Applicants shall provide verification of application to all other available resources and

programs for utility assistance.

(1) The Wisconsin Home Energy Assistance Program (WHEAP) serves as an

example of an alternate program the applicant should apply for before applying for

utility assistance.

the amount of utility assistance if the applicant’s household consists of other adults.

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(d) The amount provided for utility assistance shall not exceed three hundred dollars

($300.00) and shall only be allowed once every two (2) years. Assistance requested under

this Rule and under Rule 18 shall be counted towards the total number of requests for the

two (2) year period limit.

3-7. Reporting Changes in the Household. The applicant shall report any changes in the household

to the case manager within ten (10) business days from the change occurring.

(a) Changes in the household that shall be reported include, but are not limited to, the

following: relocation, addition or subtraction of a household member, income changes,

medical changes, submission of a social security disability application, submission of

application or receipt of assistance from other agency or program.

(b) Failure of the applicant to report changes in the household may result in suspension

of benefits until verification of the change(s) is provided to the case manager, not to exceed

thirty (30) days.

3-8. Discontinuation of Assistance. The Community Support Fund Manager reserves the right to

discontinue shelter assistance based on the following:

(a) A lack of funding availability

(b) A discovery that fraud or illegal activity has been determined to have caused

homelessness.

assistance will be discontinued.

3-9. Changes in Household Information. An applicant shall be responsible to report to the Fund

Case Manager any change(s) in the household within ten (10) business days from the change.

Changes shall include, but are not limited to the following:

(a) Relocation;

(b) Household member changes;

(d) Medical changes;

(e) Submission of Social Security Disability application; and

(f) Receipt of other agency assistance

(1) Failure of an applicant to report changes in the household may result in

suspension of assistance until verification of the change(s) is provided to the

Fund Case Manager.

(2) An applicant shall have thirty (30) days to provide the verification once

notification is received from the Fund Case Manager that verification is

required.

3-10. Lodging Assistance. Lodging Assistance may be provided in the event of extreme situations

as determined by the Fund Case Manager and the Director of Economic Support.

IV. EMERGENCY/NON-EMERGENCY MEDICAL TRAVEL

4-1. Purpose. The purpose is to assist enrolled members of the Nation with emergency and nonemergency medical travel expenses. This assistance is limited to immediate family members

to assist with travel expenses.

4-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

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4-3.

4-4.

4-5.

Eligibility Criteria. In order to be eligible for emergency/non-emergency medical travel

assistance, a person must provide a completed Community Support Fund application and the

following:

(a) Proof of enrollment in the Nation;

(b) Verifications of medical appointments which include the medical condition, date, time

and location of the appointment;

(d) Verification of a valid driver’s license for reimbursement of fuel purchases

(e) Original receipts for hotel, gas, and/or airfare which shall be dated within thirty (30)

days of travel and show total cost paid; and

Receipt of Required Documentation. Upon receipt of the completed application for

emergency/non-emergency medical travel assistance, the case manager shall determine if all

required documentation was received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

the case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for emergency/non-emergency medical travel assistance shall be valid

for thirty (30) days. If the applicant has a determination of award and/or coverage pending

with another support or assistance resource, the application will be valid for an additional

fifteen (15) days upon proof of that such determination is pending. If the applicant fails to

provide all requested documentation, the case manager shall send the applicant an

expiration notice for their application.

Non-Emergency Travel. Non-emergency travel is allowed when the applicant or immediate

family member has scheduled medical appointments as shown through medical

documentation.

(a) Documentation of scheduled appointments must be submitted and have prior approval.

(b) Non-emergent medical travel for local members with chronic serious medical needs

may be reimbursed to the applicant with a valid receipt within forty-five (45) days of

appointments. Once the application is approved, applicants within the reservation

boundires may receive assistance direcelty from the program during regular business

hours.

(1) Applicants within the reservation boundaries traveling less than sixty (60) miles

one way may be eligiable for public or tribal transportation transit passes for

verified chronic serious medical appointments.

(2) Applicants traveling less than sixty (60) miles one way may receive assistance

or reimbursement not to exceed twenty dollars ($20.00) per week for verified

chronic serious medical appointments.

(d) Non-Emergency Travel At Least Sixty (60) Miles One Way.

(1) Those who travel from sixty (60) miles up to one hundred fifty (150) miles oneway shall receive a thirty dollar ($30.00) fuel assistance. Travel may also be eligible

for reimbursement for up to thirty dollars ($30.00) with original receipts that

coincide with a medical appointment.

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4-6.

4-7.

(2) Those who travel over one hundred and fifty (150) miles one-way shall receive

a forty dollar ($40.00) fuel assistance. Travel may also be eligible for

reimbursement for up to forty dollars ($40.00) with original receipts that coincide

with a medical appointment.

(e) Fuel Assistance will be disbursed the day prior to the appointment if application is

timely and original receipts are due within seven (7) business days. If receipts are not

turned in, future requests for assistance will be denied for six (6) consecutive months

starting when the first new request is made.

(f) Hotel reimbursement shall be a maximum of seventy-five dollars ($75.00) per night for

up to a maximum of three (3) nights, and shall only be considered for approval by the Fund

Case Manager where the appointment is more than one hundred (100) miles one-way from

the residence of the applicant.

Emergency Travel. Emergency travel assistance is allowed when an immediate family

member has a sudden or worsening life-threatening illness or injury, and is provided only on

as a reimbursement of expenses.

(a) Airfare, bus, train, lodging, and vehicle fuel is limited to a combined maximum

reimbursement amount of five hundred dollars ($500.00).

(b) Multiple immediate family members are limited to a reimbursement amount of five

hundred dollars ($500.00) each.

travel one hundred (100) miles or more one-way.

(d) Hotel reimbursement shall be a maximum of seventy-five dollars ($75.00) per night.

(e) All receipts must coincide with the emergency event that required the applicant to

travel. Applicant is responsible for providing all proper documentation regarding the

illness or injury that required travel and the required receipts in order to be eligible for

reimbursement.

Auto Repairs. Auto repair assistance is allowed when the vehicle is necessary to

obtain/maintain ongoing critical medical care when no other resources exist.

(a) Auto repair assistance is limited to critical medical patients only and will be denied

when an alternate vehicle is owned and available for use;

(b) Auto repair assistance will only cover repairs that are necessary to keep the vehicle in

standard operating condition. No routine maintenance or auto body repairs shall be

eligible for assistance. Routine maintenance or repairs shall include, but is not limited to,

oil changes, brakes, tires, batteries/fuses, lights, tune-ups, exhaust systems, flushes, and

glass replacement;

($500.00) once every twelve (12) months;

(d) Emergency repairs needed to obtain critical medical care which occurs outside of the

program’s business hours, may be considered on a case by case basis, in consultation

with an independent ASE certified auto technician, and for services that occurred within

the previous ten (10) days of the application;

(e) Towing assistance may be considered on a case by case basis for reimbursement up to

maximum of two hundred and fifty dollars ($250.00) once every twelve (12) months when

the vehicle is inoperable and towed to an ASE certified mechanic.

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4-8.

Items not Covered. The Fund Case Manager is not responsible and will not make any

reservations for any form of travel. In addition, the following items, which are not all

inclusive, are not a benefit of this assistance program:

(a) Auto insurance and deductibles;

(b) Car Rentals;

(d) Auto loans and vehicle registration.

4-9. This program encourages and requests that multiple family members traveling to the same

destination carpool and share hotel rooms whenever possible.

4-10. CSF reserves the right to discontinue assistance based on funding availability.

V. MEDICAL BILL ASSISTANCE

5-1. Purpose. The purpose of this program is to assist enrolled members of the Nation with

financial support for the cost of unpaid medical bills (deductiables and copays not covered)

where no other resources exist.

5-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

5-3. Eligibility Criteria. In order to be eligible for Medical Bill assistance, a person must provide

a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation

(1) a non-enrolled parent of an enrolled minor child may apply for assistance that

directly affects the enrolled minor child;

(b) Medical billing statements for the dates of service which are within the last twelve (12)

months and be more than fifty dollars ($50.00);

network;

(d) Explanation of Benefit (EOB) statements received from the health insurance provider

showing what portion the health insurance covered;

(e) Verification that an Indian Health Service Clinic (IHS) was utilized if applicant is in

its service area;

(f) Verification that the applicant applied for all of the financial care or assistance programs

offered at the medical facility;

(g) Statements of denial of assistance or caseworker verification of denial based on

eligibility criteria, from an Indian Health Service (IHS) facility or (EOB) from any third

party insurance carrier.

5-4. Receipt of Required Documentation. Upon receipt of the completed application for medical

bill assistance, the case manager shall determine if all required documentation was received

from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for medical bill assistance shall be valid for thirty (30) days. If the

applicant has a determination of award and/or coverage pending with another support or

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assistance resource, the application will be valid for an additional fifteen (15) days upon

proof of that such determination is pending. If the applicant fails to provide all requested

documentation, the case manager shall send the applicant an expiration notice for their

application.

5-5. Financial assistance will only be available for services already rendered by a Health Care

Provider for up to a maximum of five thousand dollars ($5,000.00) within a twelve (12) month

period. An extension of this twelve (12) month period can be considered only for chronic

medical conditions, but may not exceed an additional five thousand dollars ($5,000.00).

5-6. Medical and/or hospital bills incurred from illegal activity (i.e. operating while intoxicated,

injuries due to alcohol or drug use, etc.), or medical conditions that are a direct result from

drug use, including the abuse of prescription drugs, are not eligible for assistance, except for

Rule 8 which covers Inpatient or Intensive Outpatient treatment.

5-7. Insurance denials resulting from an applicant’s failure to submit information pertinent to

processing an insurance claim are not eligible or assistance.

5-8. Medical bills that have aged beyond twelve (12) months, or which have been referred to a

collection agency are not eligible for assistance.

5-9. Chiropractic care, holistic treatment, pain clinic treatment/injections, methadone clinic,

Saboxon injection and/or nursing home and/or any assisted living facility are not eligible for

assistance.

5-10. CSF reserves the right to discontinue assistance based on funding availability.

VI. DENTAL RELATED EXPENSES

6-1. Purpose. The purpose of dental related expenses assistance is to assist enrolled members of

the Nation with financial support with the cost of dental-related services where no other

resources exist.

6-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

6-3. Approval is from the Community Support Fund case manager is required prior to receiving

treatment from a dental health care provider.

6-4. Eligibility Criteria. In order to be eligible for dental related expenses assistance, a person must

provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(1) a non-enrolled parent of an enrolled minor child may apply for assistance that

directly affects the enrolled minor child;

(b) Verification by a dentist, orthodontist, or oral surgeon of the dental procedures to be

completed, and that they are a medical need, not cosmetic, and the cost or estimated cost

of the dental services, which shall include the name, address, and Federal tax ID number

of the dental health care provider;

(d) Verification that the applicant is utilizing the Indian Health Service Clinic in his/her

service area if available;

6-5. Receipt of Required Documentation. Upon receipt of the completed application for dental

related expenses assistance, the case manager shall determine if all required documentation

was received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

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(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for dental related expenses assistance shall be valid for thirty (30) days.

If the applicant has a determination of award and/or coverage pending with another support

or assistance resource, the application will be valid for an additional fifteen (15) days upon

proof of that such determination is pending. If the applicant fails to provide all requested

documentation, the case manager shall send the applicant an expiration notice for their

application.

6-6. Upper and lower dentures are limited to a maximum of two hundred and fifty dollars ($250.00)

each per lifetime.

6-7. Financial assistance for dental related services other than dentures is limited to a maximum of

five hundred dollars ($500.00) within a twelve (12) month period.

6-8. Dental services requiring surgery or hospital care will be referred to the Medical Bill

Assistance Program (Rule 3).

6-9. Braces, implants, veneers, teeth whitening, or any other services considered strictly cosmetic

are not eligible for assistance.

6-10. CSF reserves the right to discontinue assistance based on funding availability.

VII. OPTICAL RELATED ASSISTANCE

7-1. Purpose. The purpose of the Optical related assistance program is to provide enrolled members

of the Nation with financial support with the costs associated with optical related services

where no other resources exist.

7-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

7-3. Approval from CSF is required prior to treatment or purchase.

7-4. Eligibility Criteria. In order to be eligible for Optical Related Equipment assistance, a person

must provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(1) a non-enrolled parent of an enrolled minor child may apply for assistance that

directly affects the enrolled minor child.

(b) Cost estimate of optical services this includes the name, address and Federal Tax ID

of the provider;

optometrist;

(d) Verification of optical insurance and that the ophthalmologist, optician, or optometrist

is an in-network provider.

the application for assistance.

7-5. Applicant must utilize an Indian Health Service Clinic if available, or provided verification

that such a clinic is not available.

7-6. Receipt of Required Documentation. Upon receipt of the completed application for Optical

Related assistance, the case manager shall determine if all required documentation was

received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

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(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for Optical Related assistance shall be valid for thirty (30) days. If the

applicant has a determination of award and/or coverage pending with another support or

assistance resource, the application will be valid for an additional fifteen (15) days upon

proof of that such determination is pending. If the applicant fails to provide all requested

documentation, the case manager shall send the applicant an expiration notice for their

application.

7-7. Eye glass frames and lenses are limited to a maximum of two hundred and fifty dollars

($250.00) once per twelve (12) month period, and only the actual frame and lenses are eligible

for assistance. Enhancements, including, but not limited to transitional lenses, tinting, or antireflective coatings, are not eligible for assistance.

7-8. Optical services requiring surgery or hospital care will be referred to the CSF Critical Medical

Bill program.

7-9. Transportation costs associated with reporting to a treatment/medical facility will be referred

to the CSF Critical Medical Travel Assistance program.

7-10. The following are not eligible for assistance: contact lenses, routine eye exams, vision

correction surgery (eye laser surgery), or any other services that are considered cosmetic. This

list is not exhaustive.

7-11. CSF reserves the right to discontinue assistance based on funding availability.

VIII. INPATIENT OR INTENSIVE OUTPATIENT TREATMENT ASSISTANCE

8-1. Purpose. The purpose of the Inpatient or Intensive Outpatient Treatment assistance is to

provide enrolled members of the Nation with financial support for inpatient or Intensive

Outpatient treatment who have been referred by a licensed or certified counseling agency or

program, or who have voluntarily entered into an inpatient or Intensive Outpatient treatment

program where no other resources exist.

8-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

8-3. Approval from CSF is required prior to the inpatient stay or intensive outpatient treatment in

order to receive assistance.

8-4. Eligibility Criteria. In order to be eligible for Inpatient or Intensive Outpatient Treatment

assistance, a person must provide a completed Community Support Fund application and the

following:

(a) Proof of enrollment in the Nation;

(b) Cost estimate of the Treatment Center including the name, address and Federal Tax

ID number;

catastrophic illness;

(d) Verification of health insurance and that the treatment facility is in network. If not in

network, verification is to be provided that attempts were made to find a facility in network;

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8-5.

Receipt of Required Documentation. Upon receipt of the completed application for Inpatient

Treatment assistance, the case manager shall determine if all required documentation was

received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for Inpatient Treatment assistance shall be valid for thirty (30) days. If

the applicant has a determination of award and/or coverage pending with another support

or assistance resource, the application will be valid for an additional fifteen (15) days

upon proof of that such determination is pending. If the applicant fails to provide all

requested documentation, the case manager shall send the applicant an expiration notice

for their application.

8-6. Inpatient or intensive outpatient treatment assistance is available up to a maximum of five

thousand dollars ($5,000.00) per lifetime.

8-7. Inpatient or intensive outpatient treatment assistance will be paid directly to the treatment

facility and the treatment facility must be located within the continental United States.

8-8. Transportation costs associated with reporting to a treatment facility will be referred to the

CSF Emergency/Non-emergency Medical Travel program (Rule 4 section 4-5).

8-9. Follow up care expenses in a residential facility, half-way house, or transitional shelter shall

not exceed five hundred dollars ($500.00) per month for two (2) months. Follow up care

expenses do not apply to intensive outpatient treatment stays.

8-10. Shelter Assistance may be considered for intensive outpatient treatment when immediate prior

working hours are during the hours of treatment. These hours must be verified through the

employer and treatment facility, and shall not exceed five hundred dollars ($500.00) per month

for two (2) months.

8-11. Costs for incidentals such as food, personal care items, clothing, etc. are not eligible for

assistance.

8-12. CSF reserves the right to discontinue assistance based on funding availability.

IX. MEDICAL RELATED EQUIPMENT, SUPPLIES, OR FURNITURE

9-1. Purpose. The purpose of the Medical Related Equipment, Supplies, or Furniture assistance

program is to provide enrolled members of the Nation with financial assistance with furniture,

equipment, or supplies verified by a licensed doctor as being necessary to improve or maintain

the quality of life for those applicants who are diagnosed with a life-threatening or chronic

medical condition where no other resources exist.

9-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

9-3. Prior approval must be received from the CSF before any purchases are made in order to be

eligible for assistance.

9-4. Medically related equipment, supplies, or furniture must be rented whenever available.

9-5. Eligibility Criteria. In order to be eligible for Medical Related Equipment assistance, a person

must provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

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(1) a non-enrolled parent of an enrolled minor child may apply for assistance that

directly affects the enrolled minor child.

(b) The cost estimate of supplies or equipment prior to purchasing, which shall include

the vendor name, address, and Federal Tax ID number;

(1)

If the need is on a short-term basis (less than six (6) months);

(2) The specific life-threatening or chronic medical condition; and

(3) That the equipment, supplies or furniture are need to improve or maintain

the applicant’s quality of life;

(d) Statement of denial of assistance from an Indian Health Service (HIS) facility or EOB

from any third party insurance carrier;

(e) Proof of home ownership or rental lease agreement; and

9-6. Receipt of Required Documentation. Upon receipt of the completed application for Medical

Related Equipment, Supplies, or Furniture assistance, the case manager shall determine if all

required documentation was received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for Medial Related Equipment, Supplies, or Furniture assistance shall

be valid for thirty (30) days. If the applicant has a determination of award and/or

coverage pending with another support or assistance resource, the application will be

valid for an additional fifteen (15) days upon proof of that such determination is pending.

If the applicant fails to provide all requested documentation, the case manager shall send

the applicant an expiration notice for their application.

9-7. Financial assistance for this program is limited to a maximum of two thousand dollars

($2,000.00) within a twelve (12) month period.

9-8. An additional five hundred dollars ($500.00) may be considered based on medical

documentation.

9-9. Permanent ramps require the applicant to be the homeowner. Temporary ramps must have the

written consent of the property owner.

9-10. Home renovations necessary for handicap accessibility are limited to a maximum of two

thousand dollars ($2,000) once per twelve (12) month period.

(a) Renters are not eligible for home renovations.

(b) Home renovations may include, but is not limited to, accommodations to

bathrooms, doorways, hallways for wheelchairs, or a walk-in or roll in shower.

9-11. The types of equipment, furniture or supplies to be considered for assistance may include, but

is not limited to the following: hospital bed, lift chair, wheelchair, scooter, portable or

permanent ramps, air conditioners, room air purification systems, hearing aids, artificial limbs,

vision aids, wigs, and specialty made undergarments.

9-12. CSF reserves the right to discontinue assistance based on funding availability.

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X. PRESCRIPTION REIMBURSEMENT ASSISTANCE.

10-1. Purpose. The purpose of Prescription Reimbursement assistance is to assist enrolled members

of the Nation with reimbursement of emergency prescribed medications that are needed after

regular business hours or not available at Indian Health Service Clinic.

10-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

10-3. Eligibility Criteria. In order to be eligible for Prescription Reimbursement assistance, a person

must provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(b) Verification of current group health insurance policy that covers prescriptions;

(d) Original receipts of prescription medication;

(e) Verification that the emergency medical prescription was needed after hours, which

shall include the emergency room report or discharge summary;

(f) Verification that there is no Indian Health Service Clinic within ninety (90) miles of

the applicant;

10-4. Receipt of Required Documentation. Upon receipt of the completed application for

Prescription Reimbursement assistance, the case manager shall determine if all required

documentation was received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for Prescription Reimbursement assistance shall be valid for thirty (30)

days. If the applicant has a determination of award and/or coverage pending with another

support or assistance resource, the application will be valid for an additional fifteen (15)

days upon proof of that such determination is pending. If the applicant fails to provide all

requested documentation, the case manager shall send the applicant an expiration notice

for their application.

10-5. Reimbursement for emergency prescriptions is limited to three hundred dollars ($300.00)

within a twelve (12) month period.

10-6. Prescription reimbursement must be submitted within forty-five (45) days of the original

receipt date.

10-7. Prescribed medications for chemical dependency (i.e. methadone, suboxon, etc.) are not a

covered benefit.

10-8. Denials from the IHS clinic resulting from not following preferred purchasing/care team

(contract health) will not be covered (i.e. proof of residency not provided, application not

updated, no seventy-two (72) hours notice, etc.)

10-9. CSF reserves the right to discontinue assistance based on funding availability.

XI. COBRA INSURANCE PAYMENTS

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11-1. Purpose. The purpose of COBRA insurance payments assistance is to assist enrolled members

of the Nation with payment of COBRA insurance premiums when they experience an

interruption of employment.

11-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

11-3. Eligibility Criteria. In order to be eligible for COBRA insurance assistance, a person must

provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(b) Verification of current group health insurance policy;

(d) Verification of all state and public benefits applied for if eligible;

(e) Written estimate of employer’s group health care coverage plan premium for COBRA

coverage;

(f) Verification of medical diagnosis, prognosis, and approximate length of employment

interruption;

(g) Verification of the approved medical leave from employer;

(h) Verification of all household employment within the last thirty (30) days of

submission of the application for assistance.

11-4. Receipt of Required Documentation. Upon receipt of the completed application for COBRA

insurance payments, the case manager shall determine if all required documentation was

received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for COBRA insurance payments shall be valid for thirty (30) days. If

the applicant has a determination of award and/or coverage pending with another support

or assistance resource, the application will be valid for an additional fifteen (15) days upon

proof of that such determination is pending. If the applicant fails to provide all requested

documentation, the case manager shall send the applicant an expiration notice for their

application.

11-5. COBRA insurance premium payments are limited to a maximum of five hundred dollars

($500.00) per month for a total period of three (3) months. An additional three (3) months of

COBRA Insurance premiums may be requested with additional supporting documentation

from a medical professional which indicates the applicant’s return to employment is

established and with documentation from the employer approving the extended leave time.

11-6. Upon notification of employment termination, a referral to state or public assistance will be

made.

11-7. CSF reserves the right to discontinue assistance based on funding availability.

XII. FAMILY MEDICAL LEAVE ACT WAGE REPLACEMENT

12-1. Purpose. The purpose of the Family Medical Leave Act (FMLA) Wage Replacement

assistance program is to assist enrolled members of the Nation with wage replacement when

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wages are interrupted due to the need to care for an immediate family member as approved

under the Family Medical Leave Act.

12-2. FMLA wage replacement assistance is available only to employed immediate family members

utilizing the FMLA or approved medical leave by the caregiver’s employer.

12-3. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

12-4. Eligibility Criteria. In order to be eligible for FMLA Wage Replacement assistance, a person

must provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(b) Verification that the caregiver has been employed with their company for at least

twelve (12) months, and must have worked for at least one thousand two hundred and fifty

(1250) hours in the last twelve (12) months;

(d) Verification of the medical need requiring full-time care of the immediate family

member, which indicates that continuous care is needed twenty four (24) hours per day, for

seven (7) days a week. Said verification must also specify the approximate length of time

this direct care is needed.

(e) Verification of all household income within the last thirty (30) days of submission of

the application for assistance.

12-5. Receipt of Required Documentation. Upon receipt of the completed application for FMLA

Wage Replacement assistance, the case manager shall determine if all required documentation

was received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for FMLA Wage Replacement assistance shall be valid for thirty (30)

days. If the applicant has a determination of award and/or coverage pending with another

support or assistance resource, the application will be valid for an additional fifteen (15)

days upon proof of that such determination is pending. If the applicant fails to provide all

requested documentation, the case manager shall send the applicant an expiration notice

for their application.

12-6. FMLA wage replacement shall be for a maximum of three hundred and fifty dollars ($350.00)

per week for up to twelve (12) weeks. However, wages that are less than three hundred and

fifty dollars ($350.00) per week will be paid at the actual wage rate appearing on the

caregiver’s pay stubs.

12-7. An extension of an additional twelve (12) weeks of wage replacement may be considered on a

case by case basis, and updated verification must be provided showing additional approved

FMLA leave from the caregiver’s employer.

12-8. FMLA wage replacement will not be available to caregivers who are unemployed, receiving

social security benefits, retirement benefits, or any other source of income.

12-9. A W-2 tax statement will be issued to the caregiver from the Oneida Nation Central Accounting

Department. This will be a separate W-2 tax statement from regular earnings if the caregiver

is an employee of the Oneida Nation.

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12-10. The applicant must notify the case manager ten (10) business days prior to the end of the

approved FMLA.

12-11. The wage replacement will end seven (7) days after the immediate family member being cared

for is institutionalized or passes away.

12-12. Failure of the applicant to report changes in the household will result in the termination of

benefits.

12-13. Applicants are not eligible for shelter, utilities, or any other supportive service during the time

of receiving wage replacement.

12-14. The applicant must be directly caring for an immediate family member, and not oneself.

12-15. CSF reserves the right to discontinue assistance based on funding availability.

XIII. FIRE/NATURAL DISASTER ASSISTANCE

13-1. Purpose. The purpose of the Fire/Natural Disaster Assistance program is to assist enrolled

members of the Nation with financial support for fire or natural disaster shelter expenses where

no other resources exist.

13-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

13-3. Eligibility Criteria. In order to be eligible for Fire/Natural Disaster assistance, a person must

provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(b) A police and/or fire department report specifying the fire/natural disaster and

confirming that the home is uninhabitable;

(d) Verification of assistance provided or applied for from disaster relief organizations

such as Red Cross, FEMA, etc.;

(e) Verification of all household members at the time of the fire/natural disaster;

(f) Verification of lease or mortagage lender information.

13-4. Receipt of Required Documentation. Upon receipt of the completed application for

Fire/Natural Disaster assistance, the case manager shall determine if all required

documentation was received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for Fire/Natural Disaster assistance shall be valid for thirty (45) days.

If the applicant has a determination of award and/or coverage pending with another support

or assistance resource such as Red Cross, the application will be valid for an additional

fifteen (15) days upon proof of that such determination is pending. If the applicant fails to

provide all requested documentation, the case manager shall send the applicant an

expiration notice for their application.

13-5. Temporary shelter assistance will be given for up to a maximum of fifteen (15) days with the

limit of seventy-five dollars ($75.00) per day for a grand total of one thousand and one hundred

and twenty-five dollars ($1,125.00) if shelter expenses have not been paid by other resources.

Page 17 of 23

13-6. Temporary shelter may be extended for up to an additional five (5) days upon verification from

a licensed contractor that repairs are not able to be completed within the original fifteen (15)

day time period, and alternate shelter is verified as not being available.

13-7. Immediate shelter arrangements may be made by the case manager for a hotel/motel, making

an effort to obtain a room with appliances for storing and preparing meals.

13-8. Security deposit and first month’s rent shall not exceed one thousand dollars ($1,000.00) if the

current home is uninhabitable and is in need of major repair beyond thirty (30) days. The

following additional information must be provided:

(a) Landlord verification form which shall include the amount of security deposit and

monthly rent;

(b) Copy of a new rental lease agreement;

13-10. Applicant is responsible to report to the Case Manager any changes in the current catastrophic

situation, such as assistance from other agencies, or long-term housing arrangements.

13-11. Direct vendor payment may be made up to one hundred dollars ($100.00) per family member

for clothing and basic household item needs.

13-12. Any claim of items stored in a household by persons other than residents of the household will

not be considered for assistance (i.e. stored items in basement, garage, etc.)

13-13. Some services are not eligible for assistance, including, but not limited to auto replacement,

transportation, food, storage fees, furnishings, smoke or water damage cleaning fees, and

rebuilding costs.

13-14. The CSF will not pay family members or caregivers, rather payment will be made to a valid

landlord or mortgage holder.

13-15. The CSF reserves the right to discontinue assistance in cases where fraud or illegal activity has

been determined to have caused the catastrophic event, illness, injury or emergency event

resulting in the need for shelter.

13-16. The CSF reserves the right to discontinue assistance based on funding availability.

XIV. FUNERAL TRAVEL REIMBURSEMENT

14-1. Purpose. The purpose of the Funeral travel reimbursement program is to provide a consistent

process of reimbursing enrolled members of the Nation with expenses associated with funeral

travel when there are no other resources that exist.

14-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

14-3. Eligibility Criteria. In order to be eligible for Funeral travel reimbursement, a person must

provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(b) A copy of the obituary that lists the immediate family member;

(d) Original receipts that show payment for hotel, gas, and/or airfare turned in for

reimbursement within thirty (45) days of the date of the funeral;

14-4. Receipt of Required Documentation. Upon receipt of the completed application for Funeral

Travel Reimbursement assistance, the case manager shall determine if all required

documentation was received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

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(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for Funeral Travel Reimbursement assistance shall be valid for thirty

(30) days. If the applicant has a determination of award and/or coverage pending with

another support or assistance resource, the application will be valid for an additional

fifteen (15) days upon proof of that such determination is pending. If the applicant fails

to provide all requested documentation, the case manager shall send the applicant an

expiration notice for their application.

14-5. Airfare, train, bus, lodging and vehicle fuel is limited to a combined maximum reimbursement

amount of five hundred dollars ($500.00).

(a)

Multiple immediate family members are limited to reimbursement of five hundred

dollars ($500.00) each.

(b)

Hotel lodging is limited to a maximum of seventy-five dollars ($75.00) per night

and up to two (2) nights of stay and is only for those who reside in excess of sixty (60)

miles one-way from the location of the funeral.

(c)

All receipts must coincide with the initial funeral date.

(d)

Payments will not be made for “celebrations of life” or similiar gatherings after the

family members death.

14-6. Purchases not eligible for reimbursement include, but are not limited to, rental car, car repair,

food, clothing, flowers, and actual funeral costs.

14-7. Vehicle fuel reimbursement is limited to those persons who must travel forty (40) or more

miles one-way to attend a funeral service.

14-8. Reimbursement of travel expenses will not be considered when travel was completed more

than forty-five (45) days after the verified date of the funeral.

14-9. CSF will not make any reservations for any form of travel. This assistance is by reimbursement

only.

14-10. This program encourages multiple family members traveling to the same destination to

carpool, and/or share hotel rooms whenever possible.

14-11.CSF reserves the right to discontinue assistance based on funding availability.

XV. APPLIANCE REPAIR AND REPLACEMENT: FURNACE AND WATER HEATER

15-1. Purpose. The purpose of Appliance Repair and Replacement assistance is to assist enrolled

members of the Nation with an emergency repair or replacement of a furnace or water heater

where no other resources exist.

15-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

15-3. This assistance is limited to furnaces and water heaters, and shall not include any other kind of

appliances.

15-4. Eligibility Criteria. In order to be eligible for Appliance Repair and Replacement assistance,

a person must provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(b) Two (2) cost estimates for repair of a water heater or furnace from a licensed/certified

repair professional, one (1) estimate is acceptable when weather is extremely cold and/or

Page 19 of 23

during a National emergency, to include the name, address, phone number, and Federal

Tax Identification number of the professional;

in which the applicant resides, along with proof assistance was denied; and

(d) Verification that the applicant is the owner of the home.

15-5. Receipt of Required Documentation. Upon receipt of the completed application for appliance

repair and/or replacement assistance, the case manager shall determine if all required

documentation was received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for appliance repair and/or replacement assistance shall be valid for

thirty (30) days. If the applicant has a determination of award and/or coverage pending

with another support or assistance resource, the application will be valid for an additional

fifteen (15) days upon proof of that such determination is pending. If the applicant fails

to provide all requested documentation, the case manager shall send the applicant an

expiration notice for their application.

15-6. When a cost estimate indicates that the repair costs will exceed the value of the appliance,

replacement will be considered and approved on a case by case basis.

15-7. The repair and/or replacement of a water heater shall be at least one hundred dollars ($100.00)

and not exceed six hundred dollars ($600.00) once every ten (10) years.

15-8. The repair and/or replacement of a furnace shall not exceed two thousand and five hundred

dollars ($2,500.00) once per lifetime.

15-9. The CSF reserves the right to discontinue assistance based on funding availability.

XVI. SECURITY DEPOSIT ASSISTANCE

16-1. Purpose. The purpose of the Security Deposit assistance program is to provide enrolled

members of the Nation residing in the State of Wisconsin with financial support to ensure

quality of life when shelter expenses are threatened with eviction.

16-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

16-3. Eligibility Criteria. In order to be eligible for Security Deposit assistance, a person must

provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(b) A landlord verification form completed by the potential landlord or a current

rental/lease agreement showing the amount of the security deposit;

to, a pending eviction;

(d) Eviction cannot be due to illegal activity with charges against the applicant see (125.72);

(e) The applicant shall demonstrate the ability to fulfill the terms of the rental lease. The

operators of the Fund shall not co-sign any lease.

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16-4. Receipt of Required Documentation. Upon receipt of the completed application for Security

Deposit assistance, the case manager shall determine if all required documentation was

received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for Security Deposit assistance shall be valid for thirty (30) days. If

the applicant has a determination of award and/or coverage pending with another support

or assistance resource, the application will be valid for an additional fifteen (15) days

upon proof of that such determination is pending. If the applicant fails to provide all

requested documentation, the case manager shall send the applicant an expiration notice

for their application.

16-5. Security Deposit assistance shall not exceed the amount of five hundred dollars ($500.00) and

approved once per lifetime

16-6. Security Deposit assistance is limited to one (1) person per household.

16-7. CSF will not pay family members or caregivers a security deposit; it must be a valid landlord.

16-8. CSF reserves the right to discontinue assistance based on funding availability.

XVII. SOCIAL SECURITY DISABILITY DETERMINATION SHELTER ASSISTANCE

17-1. Purpose. The purpose of the Social Security Disability Determination Shelter assistance

program is to assist enrolled members of the Nation with financial support for shelter expenses

for those waiting an eligibility determination for the Social Security Administration for a

disability finding.

17-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

17-3. Eligibility Criteria. In order to be eligible for Social Security Disability Determination Shelter

assistance, a person must provide a completed Community Support Fund application and the

following:

(a) Proof of enrollment in the Nation;

(b) Verification of a pending Social Security Disability Application;

mortgage holder that show the monthly rent and the applicant’s current status;

(d) Verification of the applicant’s current utility bills for water, heat, and electricity,

however energy assistance must be applied for before any utility bills will be considered

for payment;

(e) Verification of mortgage disability insurance, if applicable;

(f) Verification of all household income within the last thirty (30) days of submission of

the application for assistance.

17-4. Receipt of Required Documentation. Upon receipt of the completed application for Social

Security Disability Determination Shelter assistance, the case manager shall determine if all

required documentation was received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

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(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for Social Security Disability Determination Shelter assistance shall

be valid for thirty (30) days. If the applicant has a determination of award and/or

coverage pending with another support or assistance resource, the application will be

valid for an additional fifteen (15) days upon proof of that such determination is pending.

If the applicant fails to provide all requested documentation, the case manager shall send

the applicant an expiration notice for their application.

17-5. Rent/mortgage assistance shall not exceed the amount of five hundred dollars ($500.00) per

month, not to exceed twelve (12) months.

(a) Only the applicant’s portion will be considered when the household consists of other

adults.

(b) Rent/mortgage assistance will be terminated if the household fails to meet their

timely portion of the scheduled payments.

17-6. Upon receipt of the verification that all other resources have been applied for, utility assistance

will be considered for water, heat, and electricity.

(a) Only the applicant’s portion of the utility bill will be considered when the household

consists of other adults.

(b) The utility bill must be in the applicant or current household member’s name.

17-7. The applicant is responsible to report to the Case Manager any change(s) in the household

within ten (10) business day from the change occurring.

(a) Examples of household change shall include, but is not limited to the following:

relocation, household members, income, medical changes, submitted social security

disability application, or application for or receipt of other agency assistance such as

housing allowance, etc.

(b) Failure of the applicant to report changes in the household may result in suspension

of benefits until verification of the change(s) is provided to the Case Manager, but

shall not exceed thirty (30) days.

17-8. CSF will not pay family members or caregivers; the assistance is paid only to a valid landlord

or mortgage holder.

17-9. CSF reserves the right to discontinue this assistance based on funding availability.

17-10. CSF reserves the right to discontinue this assistance in cases where fraud or illegal activity has

been determined to have caused the eviction.

17-11. The Case Manager will provide ten (10) day written notification to an applicant whose

assistance under this program is being discontinued.

XVIII. UTILITY DISCONNECTION ASSISTANCE

18-1. Purpose. The purpose of the Utility Disconnection assistance program is to assist enrolled

members of the Nation with emergency financial support to ensure quality of life when home

heating and electric services are threatened with disconnection.

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18-2. Requests for assistance from the Fund shall be tied to or be a result of a catastrophic event,

illness, injury or emergency event.

18-3. Eligibility Criteria. In order to be eligible for Utility Disconnection assistance, a person must

provide a completed Community Support Fund application and the following:

(a) Proof of enrollment in the Nation;

(b) A copy of the current disconnection notice received from the utility company for the

household in which the applicant is residing;

(d) Verification of application for Energy Assistance and crisis assistance with the county

agency in which the applicant resides;

(e) Verification of payments made in each of the three (3) previous months of at least

twenty-five follars ($25.00) per month.

18-4. Receipt of Required Documentation. Upon receipt of the completed application for Utility

Disconnection assistance, the case manager shall determine if all required documentation was

received from the applicant.

(a) The applicant shall provide all documentation requested by the case manager.

(b) The case manager shall notify the applicant in writing of any necessary documentation

that was not received and is still needed.

case manager shall have up to ten (10) business days to provide the initial decision in

writing to the applicant.

(d) An application for Utility Disconnection assistance shall be valid for thirty (30)

days. If the applicant has a determination of award and/or coverage pending with another

support or assistance resource, the application will be valid for an additional fifteen (15)

days upon proof of that such determination is pending. If the applicant fails to provide all

requested documentation, the case manager shall send the applicant an expiration notice

for their application.

18-5. Requests for assistance for the payment of utilities shall only be allowed once every two (2)

years by the responsible payee. Assistance requested under this Rule and under Rule 3 shall

be counted towards the total number of requests for the two (2) year period limit.

18-6. Utility assistance shall not exceed the amount of three hundred dollars ($300.00).

18-7. CSF reserves the right to discontinue assistance based on funding availability.

End.

Adopted 01-24-2018 – Effective 01-25-2018 – LOC Certified 01-17-2018

Amended 06-09-2021 – Effective 06-09-2021 – LOC Certified 06-02-2021__

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This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.