Proof of Income:


         Housing        Assistance:


























The State of Alabama now mandates the use of the standard no income Form 125 for all NO INCOME statements.  For each household member 18 and older declaring "no income' Form 125 must be filled out.  Please visit one of our offices to request a form. Hand written statements will NO LONGER be accepted. Click here for: NO INCOME FORM 125


Please read carefully all federal and state requirements below.

If any of following applies to you or anyone in your household then you MUST have all documentation in order to be seen for your appointment.


  • Original Social Security cards for everyone in your household. (We will not accept a copy)

  • Current Alabama Picture ID of head of household including spouse, if applicable. Please check your ID expiration date.

  • An Unpaid Current Original Power/Gas Bill. Note: Utility bills MUST be in head of household or spouse’s name only. If in the Landlord’s name you must provide rental agreement or letter.

  • You MUST provide proof of Gross income for the PREVIOUS MONTH for ALL PERSONS living in the household. We cannot accept bank statements. 


Proof of income may include examples below and/or other types of income proof:

  1. Adult - Check stubs from employer, Social Security, SSI, pension, unemployment, VA benefits, or self employment records. If you are a NACOLG employee our agency requires your income.

  2. A childs - Child Support, TANF and/or Childs Social Security/SSI benefits

  3. Any other income verification information you may have.

  4. Adult - Proof you are actively seeking disability benefits for adults stating no income.

  • All household members, 18 and over, MUST PROVIDE an original NOTARIZED statement using Form 125 for anyone claiming no income for the previous month. Please make note:

    1. The person filling out your no income statement must go with you to the notary’s office. They must also list their address and phone number on the statement.

    2. The following persons cannot fill out your "no income” statement: You, a relative, an immediate family member.

    3. We will not accept a hand written statement. You MUST use Form 125.

  • Non-parental guardians MUST PROVIDE documentation from the Court or Department of Human Resources showing current permanent or temporary custody of children living in the household.

  • If you live in reduced income housing which includes

  • Public Housing, Section 8, or ANY income based housing you must bring your lease or housing choice voucher.


Our on-line utility scheduler has been added for your convenience: 



Applications will be available M-F between 8:00 a.m.-4:30 p.m. Applications should be filled out and returned by 4:00 p. m. on the 1st or 3rd Tuesday of the month for consideration. 

In order to allow limited funds to serve the most families in need, please be aware we will give preference to families that have not received financial assistance from this program in the past.


Please bring the following, as applicable, to all appointments:

  1. Valid Alabama Picture ID required for head of household

  2. Social Security Cards for ALL household members. Copies cannot be accepted.

  3. Proof of all income in household from all sources for the previous month. This includes but is not limited to (Child Support, TANF, Employment, Unemployment, Social Security, SSI, Retirement, VA, and other sources of income including family support, etc.)  ALL persons over age 18 must show proof of income. Please note that any benefits received due to a child in the home, such as TANF, child support, child’s SSI, etc. is consider your child’s income and must be brought. Every person over the age of 18 with no income of their own must bring in current proof that you are actively seeking employment through the Alabama Career Center or one of the local temp. agencies.

  4. Proof of actively seeking disability benefits for any adult stating no income.

  5. Copies of all bills paid monthly

  6. Your original utility bill showing proof of current electric service will be required.

  7. Rental lease agreement and last receipt of payment.  If you do not have a lease agreement you must provide a written statement from your landlord that includes monthly rent amount, the total amount owed, and his/her contact information.

  8. If applicable any eviction notices.


There is a new program of the Agency targeting the homeless in Colbert, Marion, Winston, Lawrence, Lauderdale and Franklin counties. Program guidelines include participants must be willing to work on goals to become self-sufficient.  Goals may include obtaining your GED, Work Keys or Ready to Work certificates, learning employment skills, budgeting and other life skills.

    *Base Criteria for the Chance Project:


  • A person or family has no nighttime residence or staying at night in a place not intended for human habitation.

  • A person or family living in a temporary public shelter or living in a hotel paid for by a charity program.

  • A person exiting an institution such as jails or substance abuse treatment facility who will be homeless.

  • A person fleeing from domestic violence, or other dangerous life-threatening condition that relates to violence.


Marion, Winston, Franklin, Lawrence Counties - 256-810-9095/256-483-6215
Lauderdale - 256-766-4330
Colbert - 256-383-3832

Program Guidelines

Community Action Agency Northwest Alabama --- Helping People, Changing Lives.