The DeKalb County Integrated Community Care Initiative (ICCI) was awarded to SVdP Georgia to assist our neighbors in DeKalb County only, who are seeking help with rent/ mortgage and utility support. Once files are uploaded you will receive notification in reference to the payment. All CMS documentation should reflect (In-Kind) assistance. Please submit appropriate documentation to show that the neighbor meets the grant criteria as noted below.

Here is the information for the income limits:

# in household                               Maximum income
1                                                        $60,200
2                                                        $68,800
3                                                        $77,400
4                                                        $86,000
5                                                        $92,900
6                                                        $99,800
7                                                        $106,650
8 or more                                         $113,550

 

PLEASE SUBMIT THE FOLLOWING FORM FOR REIMBURSEMENT:

"*" indicates required fields

MM slash DD slash YYYY
Time
:

Conference/Caseworker Information

Name of Person Submitting Request*

Client Information

Client Name*
Age Range(s) of all household members (select all that apply)*
Number of Household Members with a Disability*

Address*
This field is hidden when viewing the form
MM slash DD slash YYYY
Max. file size: 50 MB.
Drop files here or
Max. file size: 50 MB.
    PLEASE CHECK THIS BOX TO CONFIRM THAT CLIENT LIVES IN DEKALB COUNTY*
    PLEASE CHECK THIS BOX TO CONFIRM THAT THIS CLIENT MEETS THE INCOME LIMITS*
    PLEASE CHECK THE APPROPRIATE BOX TO CONFIRM THAT THIS CLIENT HAS A COVID-19 IMPACT*