Hardship Assistance

• Household income documentation (most recent paystub)
• Full police report from the accident
  Copy of your car insurance policy
• Photos of damaged car
• Invoice from body shop for repairs or document from insurance stating car is totaled
• Physician document stating injury & ability to work (if applicable)

(employee or immediate family member)

• Household income documentation (most recent paystub)
  1. NOT required if the deceased is a team member
• Itemized bill from funeral home. Must include:
  1. The deceased’s name
  2. Date of passing
  3. Amount due
  4. Funeral home name, address, and phone number

• Household income documentation (most recent paystub)
• Copy of your homeowner’s or renter’s insurance policy and/or car insurance policy, if applicable
• Photos of damage to your home and/or car
• Estimates for home repairs (homeowners only) and/or car repairs
• Copy of fire report, if applicable

(employee, spouse, or dependent)

• Household income documentation (most recent paystub)
• Physician document stating illness/injury/surgery and dates unable to work and/or date expected to return to work
• Medical and/or household bills you need assistance with (must be current on payments)
• Verification that you’ve applied for financial assistance such as short- or long-term disability, FMLA

• Household income documentation (most recent paystub)
• Letter of documentation from treatment facility/counselor
• Invoice from facility/counselor for treatment
• Household bills you need assistance with (must be current on payments)

• Household income documentation (most recent paystub)
• Full police report from date of incident
• Household bills needing assistance with (must be current on payments)
• Copy of active restraining order
• Physician document stating illness/injury/surgery and dates unable to work and/or date expected to return to work, if applicable
• Medical bills you need assistance with, if applicable

_{Additional documentation may be requested as your case moves forward.}