Forms and applications:

Accessible by clicking on the form name

 

Application for Social Services

Medical Assistance Application

Checklist for Social Services

2019 W9 form

 

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The Community Liaison is here to provide counseling, referrals to community resources and other organizations, and aide to individuals and families requiring assistance of eligible financial social service requests.

TRIBAL SOCIAL SERVICE ASSISTANCE PLAN

A Tribal Social Service application must be completed by the applicant who is applying for assistance in order for consideration. All assistance requests should be submitted in a timely manner to allow the 3-5 business day process to take place. No assistance shall not be transferred from one applicant to another as a substitute of assistance not utilized from another applicant. In regards to utility and/or rental assistance, all precautions should be made by the applicant to ensure that utility and/or rent bills do not reach an extreme amount as the total amount specified will be the only amount able to be paid. All documentation requested must be accompanied to complete the application process. All applications will be submitted to the Community Liaison office for processing. A cover letter will be created and sent to the Social Service Director for review. The Social Service Director will have the authority to approve or deny all completed applications. Applications approved by the Social Service Director will be processed by the Finance Department. In the absence of the Social Service Director, the cover letter may be sent to the President or Vice-President if the request is considered urgent.

UTILITIES:

To provide a portion of assistance needed for electric, water or sewer etc. not to exceed the maximum amount of $250.00. Utility assistance will be made payable to the vendor and sent out by mail or hand carried to local utility locations. Receipts will be required to be submitted to the finance office. Receipts must coordinate with the date the applicant received assistance. Failure to comply may result in immediate suspension from the Tribal Social Service Program for the remainder of the calendar year or until receipts can be returned, whichever occurs first. Approval will not be given to use funds as a down payment/deposit. Assistance shall be awarded only twice per calendar year between the following specified dates:  An applicant can apply for utility assistance once between the specified months of January 01 – June 30 and once between the months of July 01 – December 31.

Applicant must:

1. Be an enrolled Quechan Tribal Member or have enrolled Quechan Tribal Children in their care
   a. If the applicant is not an enrolled Quechan Tribal Member but is a parent/guardian of an enrolled Quechan Tribal child, they must submit proof of enrollment for the child and birth certificate for the child with parent listed. If the applicant is a guardian, current guardianship paperwork will be required
2. Be 18 years of age or older
3. Provide utility bill that must be in the name of the applicant requesting assistance.
   a. If the utility bill is not in the applicant’s name, proof of residence for the applicant may be provided to justify payment of utility.
4. Provide W-9 from Utility Company

HOUSING:

To provide a portion of assistance needed for household rent not to exceed the maximum amount of $300.00. Receipts will be required to be submitted to the finance office. Receipts must coordinate with the date the applicant received assistance. Failure to comply may result in immediate suspension from the Tribal Social Service Program for the remainder of the calendar year or until receipts can be returned, whichever occurs first. Approval will not be given to use funds as a down payment/deposit. Assistance shall be awarded only twice per calendar year between the following specified dates: An applicant can apply for housing assistance once between the specified months of January 01 – June 30 and once between the months of July 01 – December 31.
This line item may also be used for emergency housing for displaced families. Payments will be made payable to the vendor. Assistance shall be awarded only twice per calendar year between the following specified dates: An applicant can apply for housing assistance once between the specified months of January 01 – June 30 and once between the months of July 01 – December 31.

Applicant must:

1. Be an enrolled Quechan Tribal Member or have enrolled Quechan Tribal Children in their care
   a. If the applicant is not an enrolled Quechan Tribal Member but is a parent/guardian of an enrolled Quechan Tribal child, they must submit proof of enrollment for the child and birth certificate for the child with parent listed. If the applicant is a guardian, current guardianship paperwork will be required
2. Be 18 years of age or older
3. Provide Lease Agreement or invoice that must include the name of the applicant requesting assistance.
   a. If the applicant is not listed on the Lease Agreement, proof of residence for the applicant may be provided to justify payment of rent.
4. Provide W-9 from Landlord/Realty Company

FOOD:

To provide a portion of emergency assistance needed to purchase food. Amount issued will be based on numbers of persons in household at the rate of $50.00 per person, not to exceed the maximum amount of $200.00. A food voucher will be made payable to a vendor providing services to the Quechan Tribe. Receipts will be required to be submitted to the finance office. Receipts must coordinate with the date the applicant received assistance. Failure to comply may result in immediate suspension from the Tribal Social Service Program for the remainder of the calendar year or until receipts can be returned, whichever occurs first. If the applicant does not reside within a 50 mile radius, a check may be made payable to the applicant at the same rate. Payment will be mailed to the applicant. A receipt will be required to be returned to the finance office. Assistance shall be awarded only twice per calendar year between the following specified dates: An applicant can apply for food assistance once between the specified months of January 01 – June 30 and once between the months of July 01 – December 31.

Applicant must:

1. Be an enrolled Quechan Tribal Member or have enrolled Quechan Tribal Children in their care
   a. If the applicant is not an enrolled Quechan Tribal Member but is a parent/guardian of an enrolled Quechan Tribal child, they must submit proof of enrollment for the child and birth certificate for the child with parent listed. If the applicant is a guardian, current guardianship paperwork will be required
2. Be 18 years of age or older
3. Provide proof of residence.

MEDICAL:

To provide a portion of assistance needed to keep a doctor’s appointment out of the area not to exceed the maximum amount of $300.00. Medical Assistance may be used for food, fuel and lodging. Per Diem rates shall be used to total amount of assistance given. The Tribal Social Service Program can only assist with a total of 4 out of town medical appointments per calendar year. Medical appointments with past due dates will not be accepted. All efforts should be made for transportation via Community Health Services. Denial of transportation will be required. All Medical appointment will need to be confirmed by the Community Liaison.

This line item may also be used for travel assistance in the event the applicant has an immediate family member currently admitted to an out of town hospital/facility due to serious medical issues. No assistance shall be awarded after the patient has been discharged. Amount issued for this circumstance will be at the President/Vice-President’s discretion not to exceed $300.00 with location and length of travel period as a factor. “Immediate family” shall be defined as, Mother, Father, Legal Guardian, Sister, Brother, Son, Daughter, and Significant Other.

Medical Assistance shall not be awarded for “after-care medical needs” such as wound dressings, medications and other medical supplies and such needs should be requested by the applicant through Indian Health Services, and/or their insurance and/or other resources available to the public. 

Applicant Must:

1. Be an enrolled Quechan Tribal Member or have enrolled Quechan Tribal Children in their care
2. If the applicant is not an enrolled Quechan Tribal Member but is a parent/guardian of an enrolled Quechan Tribal child, they must submit proof of enrollment for the child and birth certificate for the child with parent listed. If the applicant is a guardian, current guardianship paperwork will be required
3. Be 18 years of age or older
4. Provide an appointment slip/letter with date and address of medical appointment.
5. Verification that medical appointment was attended will be required and should be available.

Funeral Assistance

FUNERAL COST:

The Quechan Indian Tribe will pay the cost of a funeral up to a maximum amount of $5,500.00 for one of three plans agreed upon by the Funeral Home and the Tribe. The three plans are available to the Tribe through a Yuma, Arizona funeral home for cremation on the Fort Yuma Quechan Reservation. Payment will be made directly to the funeral home.

 

Social Service funds may be used for burial assistance if the applicant meets the required criteria. Per Tribal Council’s decision, $2,500.00 of the $5,500.00 shall be used from line item to assist with Burial Costs from Bureau of Indian Affairs depending on available funding and eligibility. If the BIA Burial Costs are utilized in the amount of $2,500.00, the Quechan Tribe can only assist with $3,000.00 from Funeral Costs as the amount should not exceed a total of $5,500.00. Payment will be made directly to the funeral home.

 

The Tribe will pay up to the maximum amount of a plan in Yuma towards the cost of an out of state plan if necessary for Tribal Member. Payment will be made directly to the funeral home.

 

It will be the responsibility of the family of the deceased to pay any balance owed towards the plan of funeral services more than the maximum amount. The Tribe will not be responsible for payment or negotiating with the Funeral Home outside the approved plan costs.

FUNERAL ASSISTANCE:

To offer additional financial help of tribal cremation, the Tribe will allow up to $1,000.00 per funeral, for funerals designated for 7 hours or less, i.e.: 5:00 p.m. to 12:00 a.m., and $1,500.00 per funeral, for funerals designated for 12 hours or more, i.e. 5:00 p.m. to 5:00 a.m.  This amount will be made payable to a designated immediate tribal family member. The $1,000.00/$1,500.00 can be used to purchase scarves, material for traditional dresses, traditional singers, red and black material (9 yards), bundles for the deceased, and any other funeral expenses that the family sees fit. The Tribe will provide cigarettes, water, kitchen utensils/facility and tissue at no cost to the family.

To reduce food cost, a food voucher will be made payable to a vendor providing services to the Quechan Tribe for the family in the amount of $187.50 for funerals designated for 7 hours or less, i.e.: 5:00 p.m. to 12:00 a.m., and $375.00, for funerals designated for 12 hours or more; i.e. 5:00 p.m. to 5:00 a.m. In following our traditions, the Quechan Tribe does encourage fasting, reducing salt, grease, etc.

FUNERAL ASSISTANCE/TRAVEL:

Applications submitted for local and out of town travel (over a 50-mile radius) to attend and/or participate in a funeral will be reviewed individually and maybe approved for a local maximum amount of seventy five dollars ($75.00) and out of town for two hundred fifty dollars ($250.00).

• A list of 10 eligible applicants shall be provided to the Executive Secretary by the family during the time they will meet with the Vice-President regarding funeral arrangements. This list will determine who will receive local funeral assistance in the amount of $75.00. This list does not include those traveling from out of town or the designated immediate tribal family members who will receive the monetary assistance in the amount of $1,000.00/$1,500.00. The designated immediate tribal family member who receives the $1,000.00/$1,500.00 financial help will not be eligible to receive additional assistance for out of town or local funeral assistance.

Applications submitted for other tribal funerals for out-of-town travel (over a 50-mile radius) to attend and/or to participate in a funeral will be reviewed individually and may be approved for a maximum amount of two hundred fifty dollars ($250.00). A Funeral Assistance Application must be completed by the individual requesting assistance for consideration. This assistance is to be used strictly for travel only. Receipts will be required to be submitted to the finance office. Receipts must coordinate with the funeral date the applicant is attending. Failure to comply may result in immediate suspension from the Tribe for the remainder of the calendar year or until receipts can be returned, whichever occurs first.

Applicant must:

1. Be an enrolled Quechan Tribal Member.
2. Be 18 years of age or older.
3. Out of town Funeral requests must be accompanied by a funeral notice with a date and address where funeral services are to be held.

MEMORIAL ASSISTANCE:

No monetary assistance will be given for a memorial service for deceased tribal members.

RESERVING HOTEL ROOMS AT QUECHAN CASINO RESORT

To offer additional support for out-of-town family members who are traveling to attend a funeral in the area, a maximum of 10 hotel rooms can be reserved at Quechan Casino & Resort. The deposit and resort fees will be waived, and rooms are to be booked at the $69.00 room rate with a late checkout of 2:00 p.m.

ALL GUESTS ARE RESPONSIBLE TO PAY FOR THEIR OWN ROOMS. The Tribe will not pay for or compensate any rooms reserved for funerals as it will be the individual’s responsibility. The family may pay for the rooms on behalf of the guests if they choose. Hotel Reservations will be made depending on availability and will be made according to the following steps:

1. A list will be provided by the family to the Executive Secretary of the guests who will be checking in, and accessible handicapped services and rooms will be available if needed.
2. An email shall be generated and sent to the Administrative Executive Assistant to the CEO of Quechan Casino Resort with the list of names including the check-in date and check-out date for the reserved hotel rooms.
3. The Administrative Executive Assistant to the CEO of QCR will then check availability and secure rooms. An email will be sent to verify and provide confirmation numbers for the reserved hotel rooms.
4. If the expected guest is unable to check into the hotel room for any reason, they must contact the Executive Secretary so the room can be unsecured.

In the event that the Quechan Casino Resort has no rooms available, the Executive Secretary will locate another Hotel in the area and work with that hotel’s sales department and/or General Manager to negotiate a Bereavement Rate for the family. The Tribe will not pay for or compensate any rooms reserved for funerals as it will be the individual’s responsibility.