Request Assistance – TEST

HAAM Zip Code coverage area:

77044, 77302, 77306, 77336, 77338, 77339, 77345, 77346, 77347, 77357, 77365, 77396, 77532, 77372 - Outside of HAAM Zip Code coverage area please call United Way at 2-1-1.

Completion of Request for Assistance form does not guarantee assistance. You will be notified when your request is reviewed.

HAAM consent and release of information for Basic Needs.

• I certify that the information I have provided is true and correct to the best of my knowledge.
• I understand that providing false information to Humble Area Assistance Ministries will void eligibility services.
• I consent to the release of pertinent information contained in my file as necessary to complete services for my household, authenticate information for service consideration, provide statistical information for the purpose of continued funding, or to ensure duplication of assistance does not occur.
• I hereby authorize my housing or utility supplier to release information concerning my accounts as necessary to ensure timely processing of applicable financial assistance applications.