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2. Criteria for Requesting ARPA Household Relief Fund from the Greenwich Department of Human Services
   • Past due rent or utiliity bills
   • Greenwich residency for, at least, the past six (6) months 
   • $3,000 or less in assets  

   • If not yet retired, does not include retirement funds 
   • Does not include vehicle(s) 
   • One-time financial assistance will be beneficial 
   • Willingness to explore and implement a budgeting plan for moving forward 
   • A Gross Annual Household Income at or below the ALICE Threshold. Click here for more information.

   A case manager from the Greenwich Department of Human Services (GDHS) will follow up with you within three (3) business days of submitting the information below. Additional, information and documents, e.g., bank statements for all members of the household, will be required to make a final determination. We are here to help.

   Please note the maximum amount of financial assistance, across sources, from GDHS is $4,200 within a two-year period.

4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Unit #
15. Phone Number*
17. Email Address
19. Gross Annual Household Income*
21. Number of People in the Household*
23. Are your total assets less than $3,000?*
    -- Select One --YesNo
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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