EFORMS - Form

UBR Application

Utility Billing Relief (UBR) provides low-income Chicago residents with a reduced rate on their water, sewer, and water-sewer taxes, as well as debt relief for those who demonstrate they can manage the reduced rate bills for one year. Benefits for UBR participants include:

50% reduced rate on water, sewer, and water-sewer tax
No new late payment penalties or debt collection activity including water shut-off
Debt forgiveness after successfully completing one year with no accrued balance

The City of Chicago is operating in partnership with the Community and Economic Development Association of Cook County (CEDA), who operates the Low Income Home Energy Assistance Program (LIHEAP) in Cook County. The UBR program uses the same financial eligibility criteria as LIHEAP. If you are a Chicago homeowner of a single family home or 2-flat and are interested in enrolling in UBR, please complete the application below.

Property Verification

If you have successfully applied for a LIHEAP benefit in the last 12 months, please complete the Simplified UBR Application.

Please confirm that the information below is correct. If this information is incorrect check your City of Chicago Utility Bill for the correct account number and click here.

Utility Billing Account Number *

Address *

Dwelling Type *

City *

State *

Zip Code *

Are you applying for UBR Pre-Qualification for a Property Transfer? *

Yes

Owner Information

Please enter the name and contact information of one of the property owners. The property owner you enter must reside at the service address and must also be listed on the utility bill.

First Name *

Last Name *

Phone Number *

Email Address *

Confirm Email *

Household Members

You must complete this section for every person who has lived in the home in the past 30 days, regardless of age or residency status.

For each person, you must include:

Social Security Number or Individual Taxpayer Identification Number, if one has been issued
If self-employed, the Self-Employment Worksheet.
Income and benefits received within the last 30 calendar days.
Income received for a minor (i.e. child support or SSI) should be reported by the Parent/Guardian.

For more information on how to calculate income, please click here. Income is subject to verification; therefore records should be maintained for 12 months from this date.

First Name *

Last Name *

Gender *

Ethnicity *

Date of Birth *

Proof of Identification *

SSN or ITIN *

Form of ID

Upload Identification

Choose File

You must report all income received from [range]. To upload multiple files, use the Ctrl key when choosing the files. Amounts reported are subject to audit. Intentionally omitting or providing false information, or materially altering documents shall result in disqualification from the program and a demand for repayment of any benefits received.

Do you have income from <30-days before today> to to report?

Yes

Type of Income *

Income *

Add document *

Choose File

Description *

Total Income

Preparer Information

The person filling out this application should provide their name and relationship to the property owner here.

Relationship to Homeowner *

First Name *

Last Name *

Email Address *

Phone Number *

Address

City

State

Zip Code

The applicant gives permission for the City of Chicago to discuss any portion of this application with the representative listed above.

UBR Agreement

By entering my digital signature below, I certify that I understand and agree to the following terms and conditions:

I understand that in order to qualify for the Utility Billing Relief (UBR) Program I must own and reside at the property where I will receive the UBR Program benefit. If I move from the property while enrolled in the UBR Program I must notify the City of Chicago, and I will be unenrolled from the program and will not have any set aside balance forgiven.
I understand that if I am enrolled in the UBR Program, I will be billed at a reduced rate of 50% of my water, sewer, and water-sewer tax on my City of Chicago Utility Bill while I am enrolled in the program. My garbage fee will be assessed at the full amount.
I understand that if I am enrolled in the UBR Program, any past due balance from my City of Chicago Utility Bill will be set aside for one year. While participating, I will not be expected to make payments towards the set aside balance. If I am current on my utility bills at the completion of one year in the UBR Program, my set aside balance will be forgiven.
I understand that if I am enrolled in the UBR Program, I will be exempt from referral for debt collection and penalty accrual on past due or current charges on my City of Chicago Utility Bill.
I understand that if I am current on my reduced utility bills at the completion of one year in the UBR Program and meet the income eligibility criteria, I will be eligible to re-enroll for another year at the reduced bill rate as long as the UBR Program is still being offered.
I understand that if I am not current on my reduced utility bills at the completion of one year in the UBR Program, my set aside balance will not be forgiven but will be restored to my account and will be due immediately. I will also be removed from the UBR Program.
I understand that two unsuccessful attempts to complete 12 months in the UBR Program will render me ineligible for future UBR enrollment.
I understand that when I enroll in the UBR Program, the frequency of my billing may change. I also understand that the frequency of my billing will not be changed back to what it was prior to enrollment after I am no longer enrolled in the UBR Program.
I understand that while enrolled in the UBR Program, I cannot also receive a senior citizen sewer exemption. If I am currently receiving this exemption, it will be removed while I am in the program but will be automatically restored upon exiting the program.
I understand that by enrolling in the UBR Program, I will no longer be eligible for the MeterSave nonmetered cap. I will not be able to re-enroll in MeterSave upon exiting the UBR Program, however my meter will remain in place.
I understand that if I am in bankruptcy, or if I go into bankruptcy while participating in the UBR Program, I should consult my bankruptcy attorney regarding how bankruptcy and UBR participation may affect each other.

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UTILITY BILLING RELIEF PROGRAM

UBR Application

Property Verification

Account Not Eligible

Application Already Submitted

Error

Owner Information

Household Members

Preparer Information

Summary

UBR Agreement

Applicant Signature