FSSG Application Checklist

Along with the completed and signed FSSG application, please provide the required documentation as checked below.

  • If all necessary documents are not submitted the application may be denied.
  • FSSG funds cannot be used for costs incurred prior to FIP eligibility date.

If you are currently not employed, you must be considered as work ready by your PROMISE JOBS worker. This will be at the discretion of PROMISE JOBS and your participation in your Family Investment Agreement.

First Name:  Last Name: 

Date: 

AUTOMOTIVE

1. Car Repair

 Two estimates from certified mechanics (if vehicle has to be towed; only one estimate is required)

 Copy of a valid driver’s license

 Copy of vehicle registration showing up to date and in applicant’s name (Only 1 vehicle currently registered in your name. Two parent household applicants can have only two vehicles currently registered)

 Copy of vehicle insurance coverage (if you do not have car insurance, see below for what is needed in order for PJ to assist with this cost)

2. Car Insurance

 Estimate from insurance company (cannot be online quotes)

 Copy of valid driver’s license, or documentation to show prohibition period is over (eligible to obtain a driver’s license)

 Copy of vehicle registration showing it is up to date and in applicant’s name

3. Driver’s License Fee

 Verification of vehicle ownership (if you do not have your vehicle registered in Iowa, see below for assistance with this cost)

 Copy of vehicle insurance coverage (if you do not have car insurance, see below for what is needed in order for PJ to assist with this cost – separate application must be submitted to PJ)

 Statement from the Department of Transportation indicating the cost of service for the driver’s license fees

4. Vehicle Registration and Titling

 Verification of vehicle ownership

 Copy of driver’s license (see above for assistance)

 Proof of Insurance Coverage (see above for assistance)

 Proof that all other vehicles are taken out of applicant’s name if registered for more than one

 Statement from the Department of Transportation indicating the cost of service for the vehicle registration and/or titling fees

5. Mileage When Starting a Job

(Gas, bus passes, etc. - up to first paycheck)

 A completed Employer Statement of Earnings or written verification from employer on company letterhead verifying employment that includes start date, hours per week, rate of pay and date of 1st pay check

 Job site location

OCCUPATIONAL LICENSE OR CERTIFICATION

1. Occupational, Licensure, or Certification

 Estimate verifying cost for certification/license (i.e. CDL, CNA, etc.) including renewals

2. Self-employment start-up costs

 A detailed business plan, marketing plan and documented proof that applicant has sought resource assistance at one of the 15 Regional Small Business Development Centers (SBDC)

RELOCATION EXPENSES

  Written verification of job offer or proof of employment

 Estimates for expenses (i.e. truck rental, 1st month’s rent, etc.)

 Job Site Location

  For truck/trailer rental: Written justification showing proof applicant paid for truck trailer rental and is seeking reimbursement.

RENT/HOUSING ASSISTANCE

One month rent or amount not covered by other community resources

  Copy of rent/lease agreement showing monthly rent amount and vendor/landlord information

 If requesting payment for a delinquent payment a written statement outlining reason for delinquency and details on how you plan to maintain your payments will need to be provided as well as a copy of the delinquency notice

 Award or denial letters from local community agencies that offer rental assistance

CLOTHING

 1. Interview Attire

(must be considered work ready by your PROMISE JOBS worker - FSSG will cover essentials for interview attire)

 Estimated cost of item(s) from vendor

2. Uniforms or Professional Attire for Employment

 A completed Employer Statement of Earnings or written verification from employer on company letterhead verifying employment

 Statement from employer that is requiring uniform and name of vendor that carries uniform

 Estimated cost of item(s) from vendor

REQUIRED TOOLS OR SUPPLIES

 A completed Employer Statement of Earnings or written verification from employer on company letterhead verifying employment

   Estimated cost of item(s) from vendor

GROOMING AND PERSONAL CARE

  Estimated cost of item(s)

 Receipt of payment made showing proof applicant paid for services and is seeking reimbursement

UTILITIES

Land line phone, water, gas, or electric services

  Copy of the utility bill showing the delinquent amount and dates when costs incurred

  If requesting payment for a delinquent notice provide written statement outlining reason for delinquency and details on how you plan to maintain your utilities in current standing as well as copy of the notice

  Award or denial letters from local community agencies that offer assistance

If there are items that are not indicated on this checklist that you need assistance with, please contact your PROMISE JOBS worker to see if FSSG may cover it. List local resources List local resources Attachment F: Review Process Checklist Revised 7/2020

 

 List local resources

 

Individual