CAP (Customer Assistance Program)

Customer Name*
Customer Account Number*
Daytime Phone Number*
Alternate Phone Number
Email Address
Service Address*
Street Address City State ZIP Code
Is your Service Address also your Mailing Address?*
- My Mailing Address is the SAME as my Service Address
- My Mailing Address is DIFFERENT from my Service Address
Mailing Address*
Street Address City State ZIP Code
Total Persons Living In Your Household*
Adults + Children = Total
Choose Your Option*
- I do participate in CARE, the low-income assistance programs of either Southern California Edison or Southern California Gas Company. I am attaching a copy of a recent Southern California Edison or Southern California Gas Company bill to demonstrate my participation in CARE
- I do not participate in CARE, the low-income assistance programs of either Southern California Edison or Southern California Gas Company. However, I certify that I do qualify for CAP because my annual household income is below CAP income guidelines, or I participate in a public assistance program.
Attachment*
Accepted file types: jpg, png, pdf, Max. file size: 5 MB.
Household Income Statement

Maximum Household Income

Your household's gross annual income must be below LIRA income guidelines:

Total persons in household	Total combined annual income
1-2	$39,440
3	$49,720
4	$60,000
5	$70,280
6	$80,560
7	$90,840
8	$101,120

For each additional person, add $10,280 to the total combined annual income.

The income guidelines listed above are effective June 1, 2023 through May 31, 2024

My annual household income is*
Please select all sources of your household's annual income
- Wages or salaries
- Interest/dividends from saving accounts
- Interest/dividends from Stocks or bonds
- Interest/dividends from retirement accounts
- Unemployment benefits
- Rental or royalty income
- School grants, scholarships or other aid used for living expenses
- Profit from self-employment (IRS from Schedule C, Line 29)
- Disability payments
- Workers compensation
- Social Security, SSI, SSP
- Pensions
- Insurance settlements
- Legal settlements
- TANF (AFDC)
- Food stamps
- Child support
- Spousal support
- Cash/other income
Public Assistance Program Eligibility
Do you participate in any of the following programs? If so, please select the program(s) below.
- Medi-Cal/Medicaid
- Food Stamps/SNAP
- TANF/Tribal TANF
- WIC
- Healthy Families A&B
- LIHEAP
- SSI
- National School Lunch (NSL)
- Bureau of Indian Affairs General Assistance
- Head Start Income Eligible (Tribal Only)
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Terms and Conditions
Terms and Conditions*
- The information I have provided in this application is true and correct. I agree to provide proof of income if asked. I agree to inform Suburban Water Systems if I no longer qualify for CAP. I realize that if I receive the adjustments to my bill without qualifying for it, I may be required to return the adjustment I received. I understand that Suburban Water Systems can share my information with other utilities or their agents to enroll me in their assistance programs.

My Account

My Account

CAP (Customer Assistance Program)

How do I qualify for CAP (Customer Assistance Program)?

How else do I qualify?

Suburban Water Systems CAP Application

Household Income Statement

Maximum Household Income

Public Assistance Program Eligibility

Terms and Conditions

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