This Self-Attestation Form may only be used to request additional emergency food assistance by households who have already been determined eligible for EFA food assistance by Housing Counseling Services (HCS) during the current calendar year. This Self-Attestation Form may only be used to request additional food assistance if you meet ALL the following criteria:
- You have submitted a full EFA application this year AND your household was determined eligible for EFA food assistance
- There have been no changes to your household, address or financial circumstances since you were last determined to be eligible for EFA
- You are currently experiencing a food emergency
- You have not received EFA food assistance from HCS within the last three months
Please note that you may receive EFA emergency food assistance a maximum of three times during the calendar year (January 1 - December 31)
If you have not been determined eligible for EFA food assistance during this calendar year or if any of your circumstances have changed since you were found eligible for EFA, you must complete the full EFA application instead of this form.
EFA assistance is intended to provide short-term assistance during a temporary financial crisis. Completion of this form does not guarantee continued assistance, and all assistance is subject to review to confirm program eligibility and funding availability.
Please note that HCS may request additional supporting documentation or information related to your circumstances described in this form. This may include, but not be limited to, documentation/information regarding your household income, residency, composition, and financial need.