WISH / LIRA

Customer Name*
Customer Account Number*
Daytime Phone Number*
Alternate Phone Number
Email Address
Service Address*
Street Address City State ZIP Code
Is your Service Address also your Mailing Address?*
- My Mailing Address is the SAME as my Service Address
- My Mailing Address is DIFFERENT from my Service Address
Mailing Address*
Street Address City State ZIP Code
Total Persons Living In Your Household*
Adults + Children = Total
Choose Your Option*
- I do participate in CARE, the low-income assistance programs of either Southern California Edison or Southern California Gas Company. I am attaching a copy of a recent Southern California Edison or Southern California Gas Company bill to demonstrate my participation in CARE
- I do not participate in CARE, the low-income assistance programs of either Southern California Edison or Southern California Gas Company. However, I certify that I do qualify for LIRA because my annual household income is below LIRA income guidelines, or I participate in a public assistance program.
Attachment*
Accepted file types: jpg, png, pdf, Max. file size: 5 MB.
Household Income Statement

Maximum Household Income

Your household's gross annual income must be below LIRA income guidelines:

Total persons in household	Total combined annual income
1-2	$39,440
3	$49,720
4	$60,000
5	$70,280
6	$80,560
7	$90,840
8	$101,120

For each additional person, add $10,280 to the total combined annual income.

The income guidelines listed above are effective June 1, 2023 through May 31, 2024

My annual household income is*
Please select all sources of your household's annual income
- Wages or salaries
- Interest/dividends from saving accounts
- Interest/dividends from Stocks or bonds
- Interest/dividends from retirement accounts
- Unemployment benefits
- Rental or royalty income
- School grants, scholarships or other aid used for living expenses
- Profit from self-employment (IRS from Schedule C, Line 29)
- Disability payments
- Workers compensation
- Social Security, SSI, SSP
- Pensions
- Insurance settlements
- Legal settlements
- TANF (AFDC)
- Food stamps
- Child support
- Spousal support
- Cash/other income
Public Assistance Program Eligibility
Do you participate in any of the following programs? If so, please select the program(s) below.
- Medi-Cal/Medicaid
- Food Stamps/SNAP
- TANF/Tribal TANF
- WIC
- Healthy Families A&B
- LIHEAP
- SSI
- National School Lunch (NSL)
- Bureau of Indian Affairs General Assistance
- Head Start Income Eligible (Tribal Only)
Hidden
Terms and Conditions
Terms and Conditions*
- The information I have provided in this application is true and correct. I agree to provide proof of income if asked. I agree to inform Suburban Water Systems if I no longer qualify for LIRA. I realize that if I receive the adjustments to my bill without qualifying for it, I may be required to return the adjustment I received. I understand that Suburban Water Systems can share my information with other utilities or their agents to enroll me in their assistance programs.

My Account

How do I qualify for WISH/LIRA?

How else do I qualify?

Suburban Water Systems LIRA Application

Household Income Statement

Maximum Household Income

Public Assistance Program Eligibility

Terms and Conditions

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