The General Assistance Program provides  emergency rent and  utility assistance to eligible Johnson County, Iowa residents who have an income and resources less than 30% of the Area Median Income.  The maximum monthly income based on household size -  1 person $2,071, 2 person $2,367, 3 person $2,663, 4 person $2,954, 5 person  $3,192, 6 person $3,596, 7 person $4,054, 8 person $4,513.

If you are applying for funeral assistance please contact the office at 319-356-6090.

This is an intake form and not an application for assistance. A General Assistance Specialist will review your information and get back to you.

   

Today's date and time
Contact information
Best way to reach you
Have you been seen by General Assistance before?
Are you, or is anyone in your household, a citizen of the United States?
If no, what is your alien status?
Is anyone in your household a US Veteran?
Is anyone in your household a student taking classes past high school?
Type of assistance you are seeking?
Rent Water Electric/Gas Groceries Other
For what month are you seeking help with your rent and/or utilities?
Number of people in your household (including yourself):
Does anyone in your household receive any other type of assistance?
Food Assistance Social Security Housing/Section 8 Unemployment FIP/TANF
If receiving assistance, how much do you receive?
$
Has anyone in your household had any other income or resources in the past 30 days?
If yes, what was your gross (before taxes) income?
$
For rent, do you have a lease in your name?
For utilities, is the bill in your name?
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