About: The purpose of this online application form is to collect the required information and documentation to allow the State Water Board to process your funding application for the drinking water component of the Water and Wastewater Arrearage Payment Program.
Funding Application Requirements & Technical Assistance: The State Water Board may be able to provide technical assistance to help your water system complete this funding application.
| 1. | (Mandatory) Please provide your most current total of eligible Residential accounts in arrears. The Application will display the reported number of eligible Residential accounts in arrears from the water system’s submitted Program survey. The applicant is required to provide the total number of eligible residential accounts in arrears. This number can be smaller or larger than the total provided in the Program survey. Eligible active and inactive* residential accounts in arrears are those that accrued drinking water arrearages for services provided during March 4, 2020 through June 15, 2021. Residential customers are water system customers, including groundwater well owners charged for water in managed basins, residing in single-family residences, multifamily residences, mobile homes, including, but not limited to, mobile homes in mobile home parks, or farmworker housing that receive a bill for water service. *If your water system has transferred arrearages to a third-party debt collector, only active Residential accounts are eligible. |
| 2. | (Mandatory) Please provide your most current sum of eligible Residential arrearages (EXCLUDE LATE FEES). The Application will display the reported eligible Residential arrearages from the water system’s submitted Program survey. The applicant is required to provide the total sum of eligible Residential arrearages. This amount can be smaller or larger than the sum provided in the Program survey. Eligible Residential arrearages are those that accrued for bills that covered the COVID-19 pandemic period 03/04/2020 through 06/15/2021. If the customer’s bill (monthly, quarterly, etc.) includes the COVID-19 pandemic period start date (03/04/2020), then the whole bill, which may include services provided prior to the start date, is eligible for this Program if the customer did not pay. Any unpaid bills that do NOT include charges for drinking water services provided during the COVID-19 pandemic period from 03/04/2020 through 06/15/2021 are not eligible for the Program. As long as the bill included services for these dates, the whole outstanding bill is eligible for this Program. If your accounting system is unable to distinguish between non-payment for drinking water services from non-payment for other non-drinking water charges, please enter the estimated sum of for drinking water services only, excluding any late fees. Past due balances or arrearages for bills that were issued before the bill that includes the COVID-19 pandemic period start date (03/04/2020), are NOT eligible for the program. |
| 3. | (Mandatory) Please provide your most current total of eligible Commercial accounts in arrears. The Application will display the reported number of eligible Commercial accounts in arrears from the water system’s submitted Program survey. The applicant is required to provide the total number of eligible commercial accounts in arrears. This number can be smaller or larger than the total provided in the Program survey. Eligible active and inactive* Commercial accounts in arrears are those that accrued drinking water arrearages for services provided during March 4, 2020 through June 15, 2021. Commercial customers include commercial and institutional customers: hotels, motels, restaurants, office buildings, government and military facilities, gas stations, hospitals, educational institutions, retail establishments, dormitories, nursing homes, churches, jails, prisons, mental health facilities, addiction recovery centers, farmworker housing, and campgrounds. Commercial customers do NOT include industrial (manufacturing, chemical, refineries, cooling towers, animal & food processing, etc.); agriculture irrigation (crops, aquaculture, etc.); and landscape irrigation (parks, golf courses, etc.). *If your water system has transferred arrearages to a third-party debt collector, only active Commercial accounts are eligible. |
| 4. | (Mandatory) Please provide your most current sum of eligible Commercial arrearages (EXCLUDE LATE FEES). The Application will display the reported eligible Commercial arrearages from the water system’s submitted Program survey. The applicant is required to provide the total sum of eligible Commercial arrearages. This amount can be smaller or larger than the sum provided in the Program survey. Eligible Commercial arrearages are those that accrued for bills that covered the COVID-19 pandemic period 03/04/2020 through 06/15/2021. If the customer’s bill (monthly, quarterly, etc.) includes the COVID-19 pandemic period start date (03/04/2020), then the whole bill, which may include services provided prior to the start date, is eligible for this Program if the customer did not pay. Any unpaid bills that do NOT include charges for drinking water services provided during the COVID-19 pandemic period from 03/04/2020 through 06/15/2021 are not eligible for the Program. As long as the bill included services for these dates, the whole outstanding bill is eligible for this Program. If your accounting system is unable to distinguish between non-payment for drinking water services from non-payment for other non-drinking water charges, please enter the estimated sum of for drinking water services only, excluding any late fees. Past due balances or arrearages for bills that were issued before the bill that includes the COVID-19 pandemic period start date (03/04/2020), are NOT eligible for the program. |
| 5. | (Mandatory) Please indicate if your reported Residential and/or Commercial arrearages include any of the following: --User may select multiple-- [a] Customer arrearages that have been transferred to the third-party debt. [b] Customer arrearages that have been addressed or received funding from your system’s existing customer assistance program that was implemented during the COVID-19 pandemic period. [c] None of the above. If you select option [b], the State Water Board will contact you to discuss how your water system will comply with the Program requirements before any funding is issued. For more information, see Final Adopted CA Water & Wastewater Arrearage Guidelines: Water Arrearages, adopted September 21, 2021 |
| 6. | (Mandatory) What is your total funding application request? The applicant is required to provide the amount of funding requested from the Program. Community water system applicants must comply with all documentation and reporting requirements in the Program Guidelines. Please note that water systems must allocate the funding received to offset arrearages in accordance with the Program Guidelines and must return any moneys not credited to customers’ accounts to the State Water Board within six months of receipt. |
| 7. | (Mandatory) The applicant is required to indicate if the Administrative Contact in the State Water Board's database is the person authorized to represent their water system and accept funding from the State Water Board. This contact is required to provide a wet signature (physically sign) on the application forms required below. Forms with electronic signatures will not be accepted.
If the applicant selects “No”; the following contact fields will display so that the applicant to identify the appropriate authorized signatory. |
| 7.1 | (Mandatory if Q7 = “No”) Please indicate who the appropriate authorized representative or designee is for your water system. The authorized representative or designee provided will be validated by your water system’s District Engineer before the funding application materials will be approved. First Name: Last Name: Title: Organization: Business Email:* Business Mailing Address 1: Business Mailing Address 2: City: State: Zipcode: Work Phone: Work Cell Phone: |
| 8. | (Mandatory) Please attach any applicable documentation to support the authorized representative or designee provided above. Documentation may, but is not required to be provided using the Authorized Representative Delegation Form. If the authorized representative or designee listed above is not an authorized signatory per the Signatory Requirements Table, please provide documentation delegating authority for the authorized representative or designee to sign on behalf of the Community Water System. See the Signatory Requirements Guidelines for this process. |
| 9. | (Mandatory) You must download and complete the Conditions of Payment form provided below. Use the button to attach the completed form. This form must be physically signed by your water system’s authorized representative or designee. Forms with electronic signatures will not be accepted. If this is an aggregated application, the legal responsible entity may provide one Conditions of Payment form on behalf of all Community Water Systems included in the application. |
| 10. | (Mandatory) You must download and complete the Disbursement Request form. This form must be physically signed by your water system’s authorized representative or designee. Applicants are required to attach the completed form and then physically mail in the form. All fields on the form must be filled. If there is nothing to insert in a field, then a “0” should be inserted. Fields cannot be left blank. The original, physically signed, copy of the Disbursement Request form must be mailed to the State Water Board before payment is disbursed. Forms with electronic signatures will not be accepted. You must mail the wet signed form to:
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| 11. | (Mandatory) The distribution of Program funding can either be sent to the Community Water System’s mailing address, or the address provided on the Tax ID form. This question asks where the mailing address the State Water Board has in its database (SDWIS) is the correct mailing address for distribution of Program funding.
If the applicant selects “No”; the following mailing address fields will display so that the applicant to identify the appropriate address. |
| 11.1 | (Mandatory if 11 = “No”) Please provide the appropriate mailing address for distribution of Program funding. This address must be the one provided (or will be provided) on the Tax ID form. Business Mailing Address 1: Business Mailing Address 2: City: State: Zipcode: |
| 12. | If you have not done so already, please download and complete the Tax ID form provided below. Use the button to attach the completed form. This form must be physically signed by your water system’s authorized representative or designee or authorized fiscal representative. Forms with electronic signatures will not be accepted.
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| 13. | (Mandatory if large water system) Applicants with 3,300 service connections or more are required to submit this completed spreadsheet that includes the following information:
Use this spreadsheet template for a single water system applicant. If you are submitting an aggregated application for multiple water systems, please use this spreadsheet template. Please upload this spreadsheet in the excel format provided. |
| (Mandatory) Community water system applicants are required to certify that the information provided in this funding application is true and accurate under penalty of perjury. | |