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Notice to inform residential customers of the potential discontinuation of electric services due to non-payment, including information on certification for medical and financial assistance.

How to fill out electric notification of discontinuation

How to fill out Electric Notification of Discontinuation of Residential Services (Medical and Financial Certification)

1. Obtain the Electric Notification of Discontinuation form from your utility provider.
2. Carefully read the instructions provided with the form.
3. Fill out your personal information including name, address, and account number at the top of the form.
4. Complete the Medical Certification section if applicable, providing details of any medical conditions requiring electric service.
5. Include the signature of a licensed medical professional if required for the Medical Certification.
6. Complete the Financial Certification section if applicable, providing necessary financial information.
7. Review the completed form for any errors or missing information.
8. Submit the form to your utility provider through the specified method (mail, fax, or online submission).
9. Keep a copy of the submitted form for your records.
10. Check with the utility provider for confirmation of receipt and any next steps.

Who needs Electric Notification of Discontinuation of Residential Services (Medical and Financial Certification)?

1. Residential customers facing a discontinuation of electric services due to non-payment.
2. Individuals with medical conditions that require continuous electric service for medical devices.
3. Low-income households that may qualify for assistance programs.

For pdfFiller’s FAQs

What is Electric Notification of Discontinuation of Residential Services (Medical and Financial Certification)?

Electric Notification of Discontinuation of Residential Services (Medical and Financial Certification) is a document that certifies the medical and financial circumstances of a residential customer, which is required to be submitted when there is a proposed discontinuation of electric service.

Who is required to file Electric Notification of Discontinuation of Residential Services (Medical and Financial Certification)?

The customer who is facing the discontinuation of residential electric services due to non-payment or other reasons may be required to file this certification, especially if they have medical or financial hardships.

How to fill out Electric Notification of Discontinuation of Residential Services (Medical and Financial Certification)?

To fill out the certification, customers should provide accurate personal information, describe their medical conditions if applicable, and detail their financial situation. The form typically requires signature validation from a healthcare provider or official financial representative.

What is the purpose of Electric Notification of Discontinuation of Residential Services (Medical and Financial Certification)?

The purpose of this notification is to protect vulnerable customers from service interruptions due to medical conditions or financial hardships. It ensures that utility companies consider these factors before proceeding with the discontinuation of service.

What information must be reported on Electric Notification of Discontinuation of Residential Services (Medical and Financial Certification)?

The reported information typically includes the customer's name, account number, details of medical conditions (if any), financial status, relevant healthcare provider information, and any documentation verifying eligibility for assistance or special consideration.