Lifeline Program

FY 2027 LIFELINE PROGRAM FORM

LIFELINE INCOME DECLARATION NOTARY FORM

Lifeline Rate

Lifeline water rates will reduce the service charge for customers of the Martinez Water system who qualify.

Lifeline rates are available to those persons who qualify under the following criteria:

• Have an annual combined household income of less than the HUD “very low” poverty level set for Contra Costa County, per year, based on the number of people per household; and

• Have historical usage for preceding 12-month period (or shorter if less than 12 months’ history) of no greater than 24 units on average per billing cycle for family of four, plus additional 6 units for each additional member; and

• Occupant of a single family dwelling (served by a water meter of 1” or smaller); and must recertify with the City Finance Division annually by June 30th.

 For reference, 1 unit = 748 gallons

Proof of Income – Government Assistance

Any of the following sources of household income may qualify (other programs may also apply):

• Social Security benefit statement showing total monthly or annual benefit amount, accompanied by latest tax return or notarized letter declaring income eligibility under penalty of perjury

• SSP or SSDI award letter

• Unemployment benefits statement showing total monthly or annual benefit amount, accompanied by latest tax return or notarized letter declaring income eligibility under penalty of perjury

• Medicaid/Medi-Cal benefit statement

• Supplemental Security Income (SSI) benefit verification letter

• CalFresh/SNAP (Food Stamps) benefit verification letter

• Low Income Home Energy Assistance Program (LIHEAP) approval letter

• Women, Infants & Children (WIC) Program Verification of Participation Letter

Current “Very Low Level” (HUD figures for 2026) can be found on the current lifeline form linked above