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Utility Billing Affidavit for Indigence


  1. 1. Introduction and Program Requirements
  2. 2. Customer Information
  3. 3. Household Information
  4. 4. Acceptance
  • Introduction and Program Requirements

    1. Title II Compliance

      In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website.

    2. About the Program
      Residential customers who meet certain qualifications and are deemed to be indigent (suffering from extreme poverty) may complete an Affidavit for Indigence.
    3. Program Requirements
      The customer is financially unable to pay their City of Modesto utility bill within the normal billing cycle by demonstrating they or a member of their household is a current recipient of one of the following assistance programs: CalWorks, CalFresh, General Assistance, Medi-Cal, Supplemental Security Income (SSI), State Supplementary Payments (SSP), California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The customer demonstrates their household income is less than 200% of the federal poverty level.