{"id":375,"date":"2024-05-31T19:34:02","date_gmt":"2024-05-31T23:34:02","guid":{"rendered":"https:\/\/caincincy.org\/?page_id=375"},"modified":"2026-08-25T15:03:20","modified_gmt":"2026-08-25T19:03:20","slug":"utility","status":"publish","type":"page","link":"https:\/\/caincincy.org\/es\/utility\/","title":{"rendered":"Asistencia para servicios"},"content":{"rendered":"<h1 class=\"wp-block-heading\">Lea por favor:<\/h1>\n\n\n\n<p class=\"has-text-align-left has-custom-color-2-background-color has-background wp-block-paragraph\"><strong>A partir de marzo de 2025, CAIN solo ofrecer\u00e1 asistencia con los servicios p\u00fablicos y no asistencia para el alquiler.<\/strong> CAIN es capaz de ofrecer asistencia de servicios p\u00fablicos a los residentes de Northside (c\u00f3digo postal 45223) cuando los fondos est\u00e1n disponibles. Solicitar asistencia de servicios p\u00fablicos no garantiza que CAIN pueda ayudarle. Por favor, rellene el formulario siguiendo las instrucciones de cada pregunta. Proporcionar m\u00e1s detalles ayuda al personal de CAIN a revisar la aplicaci\u00f3n.<\/p>\n\n\n\n<p class=\"is-style-success wp-block-paragraph\">Fondos limitados disponible para adultos mayores que 60 que cualifican: <a href=\"https:\/\/www.help4seniors.org\/programs-services\/senior-utility-home-repair-assistance\/steps-to-stability-hamilton-county\/\">https:\/\/www.help4seniors.org\/programs-services\/senior-utility-home-repair-assistance\/steps-to-stability-hamilton-county\/<\/a><\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Solicitudes ser\u00e1n abiertas desde el 31 de agosto hasta el 8 de septiembre.<\/h1>\n\n\n\n<p class=\"is-style-success wp-block-paragraph\">Por favor entregue su solicitud durant el ciclo actual - desde el 31 de agosto hasta el 8 de septiembre. <\/p>\n\n\n\n<details class=\"wp-block-details is-layout-flow wp-block-details-is-layout-flow\"><summary>Utility Assistance Application<\/summary>\n<p class=\"wp-block-paragraph\">&nbsp;<\/p>\n\n\n\n<div class=\"forminator-guttenberg\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-433 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-433\" data-uid=\"6a9f97f15da35\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-433\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-433 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"433\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a9f97f15da35\" action=\"\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-433--page-0\"\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-433--page-0-label\"\n\t\t\t\tdata-step=\"0\"\n\t\t\t\tdata-label=\"Long Answer\"\n\t\t\t\tdata-actual-label=\"Page 1\"\n\t\t\t\tdata-name=\"page-break-1\"\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-13\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-13-6a9f97f15da35-label\"><span id=\"forminator-radiogroup-radio-13-6a9f97f15da35-label\" class=\"forminator-label\">This application is for utility assistance. At this time, we are not accepting applications for rent assistance. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-13-label-1\" for=\"forminator-field-radio-13-1-6a9f97f15da35\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-13\" value=\"one\" id=\"forminator-field-radio-13-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-13-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a9f97f15da35-label\"><span id=\"forminator-radiogroup-radio-1-6a9f97f15da35-label\" class=\"forminator-label\">CAIN&#039;s ability to help with utility depends on whether or not we have funding. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a9f97f15da35\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a9f97f15da35-label\"><span id=\"forminator-radiogroup-radio-2-6a9f97f15da35-label\" class=\"forminator-label\">If CAIN does have funding, assistance is not guaranteed. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a9f97f15da35\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-6a9f97f15da35-label\"><span id=\"forminator-radiogroup-radio-4-6a9f97f15da35-label\" class=\"forminator-label\">If the form is not filled out completely, your application will be rejected. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6a9f97f15da35\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-6a9f97f15da35-label\"><span id=\"forminator-radiogroup-radio-3-6a9f97f15da35-label\" class=\"forminator-label\">We WILL process all applications submitted while the application cycle is open, however if you are not accepted you will not receive a response. CAIN&#039;s team is small and we appreciate your understanding. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6a9f97f15da35\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-433--page-1\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-433--page-1-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"1\"\n\t\t\t\tdata-label=\"Page  1\"\n\t\t\t\tdata-actual-label=\"Pre-Screening\"\n\t\t\t\tdata-name=\"page-break-2\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-6a9f97f15da35-label\"><span id=\"forminator-radiogroup-radio-6-6a9f97f15da35-label\" class=\"forminator-label\">We are only able to help those who live in the 45223 zipcode. Do you currently live in the 45223 zipcode? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6a9f97f15da35\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-6\" value=\"one\" id=\"forminator-field-radio-6-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6a9f97f15da35\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-6\" value=\"two\" id=\"forminator-field-radio-6-2-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12\"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6a9f97f15da35\" id=\"forminator-field-address-1-street_address_6a9f97f15da35-label\" class=\"forminator-label\">Direcci\u00f3n <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-1-street_address_6a9f97f15da35\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1-address_line\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-address_line_6a9f97f15da35\" id=\"forminator-field-address-1-address_line_6a9f97f15da35-label\" class=\"forminator-label\">Apartamento #<\/label><input type=\"text\" name=\"address-1-address_line\" placeholder=\"\" id=\"forminator-field-address-1-address_line_6a9f97f15da35\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-line2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_6a9f97f15da35\" id=\"forminator-field-address-1-zip_6a9f97f15da35-label\" class=\"forminator-label\">C\u00f3digo Postal <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"E.g. 2000\" id=\"forminator-field-address-1-zip_6a9f97f15da35\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-7-6a9f97f15da35-label\"><span id=\"forminator-radiogroup-radio-7-6a9f97f15da35-label\" class=\"forminator-label\">Have you received rent OR utility assistance from CAIN in the last 12 months? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-6a9f97f15da35\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-7\" value=\"one\" id=\"forminator-field-radio-7-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-6a9f97f15da35\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-7\" value=\"two\" id=\"forminator-field-radio-7-2-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><label id=\"forminator-field-radio-7-label-3\" for=\"forminator-field-radio-7-3-6a9f97f15da35\" class=\"forminator-radio\" title=\"I don&#039;t remember\"><input type=\"radio\" name=\"radio-7\" value=\"I-don&#039;t-remember\" id=\"forminator-field-radio-7-3-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-7-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">I don&#8217;t remember<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a9f97f15da35\" id=\"forminator-field-textarea-1_6a9f97f15da35-label\" class=\"forminator-label\">How did you hear about CAIN&#039;s utility assistance program? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"E.g. text placeholderYou can add new line\" id=\"forminator-field-textarea-1_6a9f97f15da35\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-433--page-2\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-433--page-2-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"2\"\n\t\t\t\tdata-label=\"Pre-Screening\"\n\t\t\t\tdata-actual-label=\"Short Answer\"\n\t\t\t\tdata-name=\"page-break-3\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a9f97f15da35\" id=\"forminator-field-name-1_6a9f97f15da35-label\" class=\"forminator-label\">Please write your first and last name. <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-1_6a9f97f15da35\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a9f97f15da35\" id=\"forminator-field-phone-1_6a9f97f15da35-label\" class=\"forminator-label\">Please list your phone number. <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. +1 300 400 5000\" id=\"forminator-field-phone-1_6a9f97f15da35\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a9f97f15da35\" id=\"forminator-field-email-1_6a9f97f15da35-label\" class=\"forminator-label\">If you have one, please list your email address.<\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_6a9f97f15da35\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a9f97f15da35\" id=\"forminator-field-name-2_6a9f97f15da35-label\" class=\"forminator-label\">What is the name of your utility company? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"E.g. Duke\" id=\"forminator-field-name-2_6a9f97f15da35\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6a9f97f15da35\" id=\"forminator-field-email-2_6a9f97f15da35-label\" class=\"forminator-label\">Please provide your account number <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"\" id=\"forminator-field-email-2_6a9f97f15da35\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6a9f97f15da35\" id=\"forminator-field-upload-1_6a9f97f15da35-label\" class=\"forminator-label\">Upload a picture or pdf file of your bill. <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-file-upload\" data-element=\"upload-1_6a9f97f15da35\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_6a9f97f15da35\" class=\"forminator-input-file-required do-validate\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.woff,.woff2,.ttf,.eot,.otf,.heif,.videopress,image\/jpeg,image\/gif,image\/png,image\/bmp,image\/tiff,image\/webp,image\/avif,image\/x-icon,image\/heic,video\/x-ms-asf,video\/x-ms-wmv,video\/x-ms-wmx,video\/x-ms-wm,video\/avi,video\/divx,video\/x-flv,video\/quicktime,video\/mpeg,video\/mp4,video\/ogg,video\/webm,video\/x-matroska,video\/3gpp,video\/3gpp2,text\/plain,text\/csv,text\/tab-separated-values,text\/calendar,text\/richtext,text\/vtt,audio\/mpeg,audio\/aac,audio\/x-realaudio,audio\/wav,audio\/ogg,audio\/flac,audio\/midi,audio\/x-ms-wma,audio\/x-ms-wax,audio\/x-matroska,application\/rtf,application\/pdf,application\/java,application\/x-tar,application\/zip,application\/x-gzip,application\/x-7z-compressed,application\/octet-stream,application\/msword,application\/vnd.ms-powerpoint,application\/vnd.ms-write,application\/vnd.ms-excel,application\/vnd.ms-access,application\/vnd.ms-project,application\/vnd.openxmlformats-officedocument.wordprocessingml.document,application\/vnd.ms-word.document.macroEnabled.12,application\/vnd.openxmlformats-officedocument.wordprocessingml.template,application\/vnd.ms-word.template.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.sheet,application\/vnd.ms-excel.sheet.macroEnabled.12,application\/vnd.ms-excel.sheet.binary.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.template,application\/vnd.ms-excel.template.macroEnabled.12,application\/vnd.ms-excel.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.presentation,application\/vnd.ms-powerpoint.presentation.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slideshow,application\/vnd.ms-powerpoint.slideshow.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.template,application\/vnd.ms-powerpoint.template.macroEnabled.12,application\/vnd.ms-powerpoint.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slide,application\/vnd.ms-powerpoint.slide.macroEnabled.12,application\/onenote,application\/oxps,application\/vnd.ms-xpsdocument,application\/vnd.oasis.opendocument.text,application\/vnd.oasis.opendocument.presentation,application\/vnd.oasis.opendocument.spreadsheet,application\/vnd.oasis.opendocument.graphics,application\/vnd.oasis.opendocument.chart,application\/vnd.oasis.opendocument.database,application\/vnd.oasis.opendocument.formula,application\/wordperfect,application\/vnd.apple.keynote,application\/vnd.apple.numbers,application\/vnd.apple.pages,image\/heif\" tabindex=\"-1\"><button id=\"forminator-field-upload-1_6a9f97f15da35_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_6a9f97f15da35\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6a9f97f15da35\" id=\"forminator-field-textarea-5_6a9f97f15da35-label\" class=\"forminator-label\">What is the billing period for your utility bill?<\/label><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_6a9f97f15da35\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-433--page-3\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-433--page-3-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"3\"\n\t\t\t\tdata-label=\"Short Answer\"\n\t\t\t\tdata-actual-label=\"Page 4\"\n\t\t\t\tdata-name=\"page-break-5\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-9\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-9-6a9f97f15da35-label\"><span id=\"forminator-radiogroup-radio-9-6a9f97f15da35-label\" class=\"forminator-label\">How many months are you behind on your utility bill? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-9-label-1\" for=\"forminator-field-radio-9-1-6a9f97f15da35\" class=\"forminator-radio\" title=\"Not behind yet\"><input type=\"radio\" name=\"radio-9\" value=\"one\" id=\"forminator-field-radio-9-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-9-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Not behind yet<\/span><\/label><label id=\"forminator-field-radio-9-label-2\" for=\"forminator-field-radio-9-2-6a9f97f15da35\" class=\"forminator-radio\" title=\"1 month behind\"><input type=\"radio\" name=\"radio-9\" value=\"two\" id=\"forminator-field-radio-9-2-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-9-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">1 month behind<\/span><\/label><label id=\"forminator-field-radio-9-label-3\" for=\"forminator-field-radio-9-3-6a9f97f15da35\" class=\"forminator-radio\" title=\"2 months behind\"><input type=\"radio\" name=\"radio-9\" value=\"2-months-behind\" id=\"forminator-field-radio-9-3-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-9-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">2 months behind<\/span><\/label><label id=\"forminator-field-radio-9-label-4\" for=\"forminator-field-radio-9-4-6a9f97f15da35\" class=\"forminator-radio\" title=\"3 or more months behind\"><input type=\"radio\" name=\"radio-9\" value=\"3-or-more-months-behind\" id=\"forminator-field-radio-9-4-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-9-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">3 or more months behind<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a9f97f15da35-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a9f97f15da35-label\" class=\"forminator-label\">For which months do you owe? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-1-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"January\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-1-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">January<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-2-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"February\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-2-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">February<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-3-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"March\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"March\" id=\"forminator-field-checkbox-1-3-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-3-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">March<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-4-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"April\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"April\" id=\"forminator-field-checkbox-1-4-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-4-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">April<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-5-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"May\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"May\" id=\"forminator-field-checkbox-1-5-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-5-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">May<\/span><\/label><label id=\"forminator-field-checkbox-1-6-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-6-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"June\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"June\" id=\"forminator-field-checkbox-1-6-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-6-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">June<\/span><\/label><label id=\"forminator-field-checkbox-1-7-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-7-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"July\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"July\" id=\"forminator-field-checkbox-1-7-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-7-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">July<\/span><\/label><label id=\"forminator-field-checkbox-1-8-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-8-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"August\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"August\" id=\"forminator-field-checkbox-1-8-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-8-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">August<\/span><\/label><label id=\"forminator-field-checkbox-1-9-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-9-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"September\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"September\" id=\"forminator-field-checkbox-1-9-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-9-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">September<\/span><\/label><label id=\"forminator-field-checkbox-1-10-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-10-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"October\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"October\" id=\"forminator-field-checkbox-1-10-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-10-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">October<\/span><\/label><label id=\"forminator-field-checkbox-1-11-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-11-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"November\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"November\" id=\"forminator-field-checkbox-1-11-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-11-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">November<\/span><\/label><label id=\"forminator-field-checkbox-1-12-6a9f97f15da35-label\" for=\"forminator-field-checkbox-1-12-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"December\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"December\" id=\"forminator-field-checkbox-1-12-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-1-12-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">December<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-2\" class=\"forminator-field-currency forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-currency-2_6a9f97f15da35\" id=\"forminator-field-currency-2_6a9f97f15da35-label\" class=\"forminator-label\">What is the total amount that you owe? <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-2\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-currency-2_6a9f97f15da35\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-3\" class=\"forminator-field-currency forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-currency-3_6a9f97f15da35\" id=\"forminator-field-currency-3_6a9f97f15da35-label\" class=\"forminator-label\">What is the amount that you are requesting assistance for? This number may be the same as the total amount you owe. <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-3\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-currency-3_6a9f97f15da35\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12\"><label for=\"forminator-field-date-1\" id=\"forminator-field-date-1-label\" class=\"forminator-label\">When is\/was the due date? <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-date-select\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-1-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-433__field--date-1-month_6a9f97f15da35\" id=\"forminator-field-433__field--date-1-month_6a9f97f15da35-label\" class=\"forminator-label\">Month<\/label><select name=\"date-1-month\" id=\"forminator-field-433__field--date-1-month_6a9f97f15da35\" class=\"forminator-select2\" data-format=\"mm\/dd\/yy\" data-parent=\"date-1\" aria-labelledby=\"forminator-field-433__field--date-1-month_6a9f97f15da35-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Select month<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><\/div><\/div><div id=\"date-1-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-433__field--date-1-day_6a9f97f15da35\" id=\"forminator-field-433__field--date-1-day_6a9f97f15da35-label\" class=\"forminator-label\">Day<\/label><select name=\"date-1-day\" id=\"forminator-field-433__field--date-1-day_6a9f97f15da35\" class=\"forminator-select2\" data-format=\"mm\/dd\/yy\" data-parent=\"date-1\" aria-labelledby=\"forminator-field-433__field--date-1-day_6a9f97f15da35-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Select day<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><\/div><\/div><div id=\"date-1-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-433__field--date-1-year_6a9f97f15da35\" id=\"forminator-field-433__field--date-1-year_6a9f97f15da35-label\" class=\"forminator-label\">Year<\/label><select name=\"date-1-year\" id=\"forminator-field-433__field--date-1-year_6a9f97f15da35\" class=\"forminator-select2\" data-format=\"mm\/dd\/yy\" data-parent=\"date-1\" aria-labelledby=\"forminator-field-433__field--date-1-year_6a9f97f15da35-label\" data-default-value=\"2026\"><option value=\"\" >Select Year<\/option><option value=\"2126\" >2126<\/option><option value=\"2125\" >2125<\/option><option value=\"2124\" >2124<\/option><option value=\"2123\" >2123<\/option><option value=\"2122\" >2122<\/option><option value=\"2121\" >2121<\/option><option value=\"2120\" >2120<\/option><option value=\"2119\" >2119<\/option><option value=\"2118\" >2118<\/option><option value=\"2117\" >2117<\/option><option value=\"2116\" >2116<\/option><option value=\"2115\" >2115<\/option><option value=\"2114\" >2114<\/option><option value=\"2113\" >2113<\/option><option value=\"2112\" >2112<\/option><option value=\"2111\" >2111<\/option><option value=\"2110\" >2110<\/option><option value=\"2109\" >2109<\/option><option value=\"2108\" >2108<\/option><option value=\"2107\" >2107<\/option><option value=\"2106\" >2106<\/option><option value=\"2105\" >2105<\/option><option value=\"2104\" >2104<\/option><option value=\"2103\" >2103<\/option><option value=\"2102\" >2102<\/option><option value=\"2101\" >2101<\/option><option value=\"2100\" >2100<\/option><option value=\"2099\" >2099<\/option><option value=\"2098\" >2098<\/option><option value=\"2097\" >2097<\/option><option value=\"2096\" >2096<\/option><option value=\"2095\" >2095<\/option><option value=\"2094\" >2094<\/option><option value=\"2093\" >2093<\/option><option value=\"2092\" >2092<\/option><option value=\"2091\" >2091<\/option><option value=\"2090\" >2090<\/option><option value=\"2089\" >2089<\/option><option value=\"2088\" >2088<\/option><option value=\"2087\" >2087<\/option><option value=\"2086\" >2086<\/option><option value=\"2085\" >2085<\/option><option value=\"2084\" >2084<\/option><option value=\"2083\" >2083<\/option><option value=\"2082\" >2082<\/option><option value=\"2081\" >2081<\/option><option value=\"2080\" >2080<\/option><option value=\"2079\" >2079<\/option><option value=\"2078\" >2078<\/option><option value=\"2077\" >2077<\/option><option value=\"2076\" >2076<\/option><option value=\"2075\" >2075<\/option><option value=\"2074\" >2074<\/option><option value=\"2073\" >2073<\/option><option value=\"2072\" >2072<\/option><option value=\"2071\" >2071<\/option><option value=\"2070\" >2070<\/option><option value=\"2069\" >2069<\/option><option value=\"2068\" >2068<\/option><option value=\"2067\" >2067<\/option><option value=\"2066\" >2066<\/option><option value=\"2065\" >2065<\/option><option value=\"2064\" >2064<\/option><option value=\"2063\" >2063<\/option><option value=\"2062\" >2062<\/option><option value=\"2061\" >2061<\/option><option value=\"2060\" >2060<\/option><option value=\"2059\" >2059<\/option><option value=\"2058\" >2058<\/option><option value=\"2057\" >2057<\/option><option value=\"2056\" >2056<\/option><option value=\"2055\" >2055<\/option><option value=\"2054\" >2054<\/option><option value=\"2053\" >2053<\/option><option value=\"2052\" >2052<\/option><option value=\"2051\" >2051<\/option><option value=\"2050\" >2050<\/option><option value=\"2049\" >2049<\/option><option value=\"2048\" >2048<\/option><option value=\"2047\" >2047<\/option><option value=\"2046\" >2046<\/option><option value=\"2045\" >2045<\/option><option value=\"2044\" >2044<\/option><option value=\"2043\" >2043<\/option><option value=\"2042\" >2042<\/option><option value=\"2041\" >2041<\/option><option value=\"2040\" >2040<\/option><option value=\"2039\" >2039<\/option><option value=\"2038\" >2038<\/option><option value=\"2037\" >2037<\/option><option value=\"2036\" >2036<\/option><option value=\"2035\" >2035<\/option><option value=\"2034\" >2034<\/option><option value=\"2033\" >2033<\/option><option value=\"2032\" >2032<\/option><option value=\"2031\" >2031<\/option><option value=\"2030\" >2030<\/option><option value=\"2029\" >2029<\/option><option value=\"2028\" >2028<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" selected=\"selected\">2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-433--page-4\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-433--page-4-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"4\"\n\t\t\t\tdata-label=\"Page  4\"\n\t\t\t\tdata-actual-label=\"Short Answer\"\n\t\t\t\tdata-name=\"page-break-4\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-6a9f97f15da35-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-6a9f97f15da35-label\" class=\"forminator-label\">Are you receiving income? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-2-1-6a9f97f15da35-label\" for=\"forminator-field-checkbox-2-1-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"I have no income\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-2-1-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I have no income<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6a9f97f15da35-label\" for=\"forminator-field-checkbox-2-2-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"I work full time\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-2-2-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I work full time<\/span><\/label><label id=\"forminator-field-checkbox-2-3-6a9f97f15da35-label\" for=\"forminator-field-checkbox-2-3-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"I work part-time\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"I-work-part-time\" id=\"forminator-field-checkbox-2-3-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-2-3-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I work part-time<\/span><\/label><label id=\"forminator-field-checkbox-2-4-6a9f97f15da35-label\" for=\"forminator-field-checkbox-2-4-6a9f97f15da35\" class=\"forminator-checkbox\" title=\"I receive another form of income like SSI or disability\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"I-receive-another-form-of-income-like-SSI-or-disability\" id=\"forminator-field-checkbox-2-4-6a9f97f15da35\" aria-labelledby=\"forminator-field-checkbox-2-4-6a9f97f15da35-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">I receive another form of income like SSI or disability<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-4\" class=\"forminator-field-currency forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-currency-4_6a9f97f15da35\" id=\"forminator-field-currency-4_6a9f97f15da35-label\" class=\"forminator-label\">What is the amount of your current monthly income? <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-4\" value=\"0.00\" placeholder=\"E.g. 10\" id=\"forminator-field-currency-4_6a9f97f15da35\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-10\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-10-6a9f97f15da35-label\"><span id=\"forminator-radiogroup-radio-10-6a9f97f15da35-label\" class=\"forminator-label\">Are you currently looking for a job? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-10-label-1\" for=\"forminator-field-radio-10-1-6a9f97f15da35\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-10\" value=\"one\" id=\"forminator-field-radio-10-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-10-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-10-label-2\" for=\"forminator-field-radio-10-2-6a9f97f15da35\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-10\" value=\"two\" id=\"forminator-field-radio-10-2-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-10-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><label id=\"forminator-field-radio-10-label-3\" for=\"forminator-field-radio-10-3-6a9f97f15da35\" class=\"forminator-radio\" title=\"I already have a job or I am unable to work\"><input type=\"radio\" name=\"radio-10\" value=\"I-already-have-a-job-or-I-am-unable-to-work\" id=\"forminator-field-radio-10-3-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-10-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">I already have a job or I am unable to work<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-433--page-5\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-433--page-5-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"5\"\n\t\t\t\tdata-label=\"Short Answer\"\n\t\t\t\tdata-actual-label=\"Long Answer\"\n\t\t\t\tdata-name=\"\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a9f97f15da35\" id=\"forminator-field-textarea-2_6a9f97f15da35-label\" class=\"forminator-label\">Why are you behind on your utility bill? Please describe as much as you&#039;d like. <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a9f97f15da35\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a9f97f15da35\" id=\"forminator-field-textarea-3_6a9f97f15da35-label\" class=\"forminator-label\">If CAIN is able to assist, what is your plan moving forward to be able to pay your utility? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6a9f97f15da35\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a9f97f15da35\" id=\"forminator-field-textarea-4_6a9f97f15da35-label\" class=\"forminator-label\">Is there anything else you&#039;d like CAIN to know when reviewing your application? (if someone in the household is waiting on benefits, about to start a new job, etc.)<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6a9f97f15da35\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a9f97f15da35\" id=\"forminator-field-text-1_6a9f97f15da35-label\" class=\"forminator-label\">If someone assisted you in filling out this form, please type their name and relationship to you in the box below. If you filled this form out yourself, please skip this question.<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a9f97f15da35\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-14\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-14-6a9f97f15da35-label\"><span id=\"forminator-radiogroup-radio-14-6a9f97f15da35-label\" class=\"forminator-label\">If you are accepted, you will not be eligible again for rent or utility assistance for 12 months. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-14-label-1\" for=\"forminator-field-radio-14-1-6a9f97f15da35\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-14\" value=\"one\" id=\"forminator-field-radio-14-1-6a9f97f15da35\" aria-labelledby=\"forminator-field-radio-14-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Submit application<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"0fc41f0af0\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/375\" \/><input type=\"hidden\" name=\"form_id\" value=\"433\"><input type=\"hidden\" name=\"page_id\" value=\"375\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/caincincy.org\/es\/utility\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/form><\/div>\n<\/details>\n\n\n\n<details class=\"wp-block-details is-layout-flow wp-block-details-is-layout-flow\"><summary>Solicitud Para Asistencia de Servicios P\u00fablicos<\/summary>\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div class=\"forminator-guttenberg\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1993 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1993\" data-uid=\"6a9f97f165672\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1993\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1993 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1993\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a9f97f165672\" action=\"\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-1993--page-0\"\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-1993--page-0-label\"\n\t\t\t\tdata-step=\"0\"\n\t\t\t\tdata-label=\"Respuesta Larga\"\n\t\t\t\tdata-actual-label=\"P\u00e1gina 1\"\n\t\t\t\tdata-name=\"page-break-1\"\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-13\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-13-6a9f97f165672-label\"><span id=\"forminator-radiogroup-radio-13-6a9f97f165672-label\" class=\"forminator-label\">Esta aplicaci\u00f3n es para asistencia de servicios p\u00fablicos. En este moment, no estamos aceptando solicitudes para alquiler. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-13-label-1\" for=\"forminator-field-radio-13-1-6a9f97f165672\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-13\" value=\"one\" id=\"forminator-field-radio-13-1-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-13-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a9f97f165672-label\"><span id=\"forminator-radiogroup-radio-1-6a9f97f165672-label\" class=\"forminator-label\">La capacidad de CAIN para ayudar con los servicios p\u00fablicos depende de si tenemos fondos o no. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a9f97f165672\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a9f97f165672-label\"><span id=\"forminator-radiogroup-radio-2-6a9f97f165672-label\" class=\"forminator-label\">Si CAIN tiene fondos, la asistencia no est\u00e1 garantizada. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a9f97f165672\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-6a9f97f165672-label\"><span id=\"forminator-radiogroup-radio-4-6a9f97f165672-label\" class=\"forminator-label\">Si el formulario no se completa en su totalidad, su solicitud ser\u00e1 rechazada. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6a9f97f165672\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-1-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-6a9f97f165672-label\"><span id=\"forminator-radiogroup-radio-3-6a9f97f165672-label\" class=\"forminator-label\">S\u00ed procesaremos todas aplicaciones entregadas mientras el ciclo de aplicaciones est\u00e1 abierto, sin embargo si no est\u00e1 aceptado no recibir\u00e1 una respuesta. El equipo de CAIN es peque\u00f1o y apreciamos su entendimiento. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6a9f97f165672\" class=\"forminator-radio\" title=\"OK\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-1-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">OK<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-1993--page-1\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-1993--page-1-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"1\"\n\t\t\t\tdata-label=\"P\u00e1gina 1\"\n\t\t\t\tdata-actual-label=\"Pre-Screening\"\n\t\t\t\tdata-name=\"page-break-2\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-6a9f97f165672-label\"><span id=\"forminator-radiogroup-radio-6-6a9f97f165672-label\" class=\"forminator-label\">Solo podemos ayudar personas que viven en el c\u00f3digo postal 45223. \u00bfVive actualmente en el c\u00f3digo postal 45223? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6a9f97f165672\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-6\" value=\"one\" id=\"forminator-field-radio-6-1-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6a9f97f165672\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-6\" value=\"two\" id=\"forminator-field-radio-6-2-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12\"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6a9f97f165672\" id=\"forminator-field-address-1-street_address_6a9f97f165672-label\" class=\"forminator-label\">Direcci\u00f3n <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Ej. 4949 Hamilton Ave.\" id=\"forminator-field-address-1-street_address_6a9f97f165672\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1-address_line\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-address_line_6a9f97f165672\" id=\"forminator-field-address-1-address_line_6a9f97f165672-label\" class=\"forminator-label\">Apartamento #<\/label><input type=\"text\" name=\"address-1-address_line\" placeholder=\"\" id=\"forminator-field-address-1-address_line_6a9f97f165672\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-line2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_6a9f97f165672\" id=\"forminator-field-address-1-zip_6a9f97f165672-label\" class=\"forminator-label\">C\u00f3digo Postal <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"Ej. 45223\" id=\"forminator-field-address-1-zip_6a9f97f165672\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-7-6a9f97f165672-label\"><span id=\"forminator-radiogroup-radio-7-6a9f97f165672-label\" class=\"forminator-label\">\u00bfHa recibido asistencia para el alquiler o los servicios p\u00fablicos de CAIN en los \u00faltimos 12 meses? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-6a9f97f165672\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-7\" value=\"one\" id=\"forminator-field-radio-7-1-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-6a9f97f165672\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-7\" value=\"two\" id=\"forminator-field-radio-7-2-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><label id=\"forminator-field-radio-7-label-3\" for=\"forminator-field-radio-7-3-6a9f97f165672\" class=\"forminator-radio\" title=\"No me acuerdo\"><input type=\"radio\" name=\"radio-7\" value=\"I-don&#039;t-remember\" id=\"forminator-field-radio-7-3-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-7-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No me acuerdo<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a9f97f165672\" id=\"forminator-field-textarea-1_6a9f97f165672-label\" class=\"forminator-label\">\u00bfC\u00f3mo se enter\u00f3 del programa de asistencia para los servicios p\u00fablicos de CAIN? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a9f97f165672\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-1993--page-2\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-1993--page-2-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"2\"\n\t\t\t\tdata-label=\"Pre-Screening\"\n\t\t\t\tdata-actual-label=\"Respuesta Corta\"\n\t\t\t\tdata-name=\"page-break-3\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a9f97f165672\" id=\"forminator-field-name-1_6a9f97f165672-label\" class=\"forminator-label\">Por favor, escriba su nombre y apellido. <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Ej. Maria Gutierrez\" id=\"forminator-field-name-1_6a9f97f165672\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a9f97f165672\" id=\"forminator-field-phone-1_6a9f97f165672-label\" class=\"forminator-label\">Por favor, escriba su n\u00famero tel\u00e9fono. <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Ej. +1 300 400 5000\" id=\"forminator-field-phone-1_6a9f97f165672\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a9f97f165672\" id=\"forminator-field-email-1_6a9f97f165672-label\" class=\"forminator-label\">Si tiene uno, indique su correo electr\u00f3nico.<\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Ej. maria.g@gmail.com\" id=\"forminator-field-email-1_6a9f97f165672\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a9f97f165672\" id=\"forminator-field-name-2_6a9f97f165672-label\" class=\"forminator-label\">\u00bfQu\u00e9 es el nombre de su empresa de servicios p\u00fablicos? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"Ej. Duke\" id=\"forminator-field-name-2_6a9f97f165672\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6a9f97f165672\" id=\"forminator-field-email-2_6a9f97f165672-label\" class=\"forminator-label\">Por favor, proporcione su n\u00famero de cuenta <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"\" id=\"forminator-field-email-2_6a9f97f165672\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6a9f97f165672\" id=\"forminator-field-upload-1_6a9f97f165672-label\" class=\"forminator-label\">Cargue una imagen o pdf de su factura. <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-file-upload\" data-element=\"upload-1_6a9f97f165672\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_6a9f97f165672\" class=\"forminator-input-file-required do-validate\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.woff,.woff2,.ttf,.eot,.otf,.heif,.videopress,image\/jpeg,image\/gif,image\/png,image\/bmp,image\/tiff,image\/webp,image\/avif,image\/x-icon,image\/heic,video\/x-ms-asf,video\/x-ms-wmv,video\/x-ms-wmx,video\/x-ms-wm,video\/avi,video\/divx,video\/x-flv,video\/quicktime,video\/mpeg,video\/mp4,video\/ogg,video\/webm,video\/x-matroska,video\/3gpp,video\/3gpp2,text\/plain,text\/csv,text\/tab-separated-values,text\/calendar,text\/richtext,text\/vtt,audio\/mpeg,audio\/aac,audio\/x-realaudio,audio\/wav,audio\/ogg,audio\/flac,audio\/midi,audio\/x-ms-wma,audio\/x-ms-wax,audio\/x-matroska,application\/rtf,application\/pdf,application\/java,application\/x-tar,application\/zip,application\/x-gzip,application\/x-7z-compressed,application\/octet-stream,application\/msword,application\/vnd.ms-powerpoint,application\/vnd.ms-write,application\/vnd.ms-excel,application\/vnd.ms-access,application\/vnd.ms-project,application\/vnd.openxmlformats-officedocument.wordprocessingml.document,application\/vnd.ms-word.document.macroEnabled.12,application\/vnd.openxmlformats-officedocument.wordprocessingml.template,application\/vnd.ms-word.template.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.sheet,application\/vnd.ms-excel.sheet.macroEnabled.12,application\/vnd.ms-excel.sheet.binary.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.template,application\/vnd.ms-excel.template.macroEnabled.12,application\/vnd.ms-excel.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.presentation,application\/vnd.ms-powerpoint.presentation.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slideshow,application\/vnd.ms-powerpoint.slideshow.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.template,application\/vnd.ms-powerpoint.template.macroEnabled.12,application\/vnd.ms-powerpoint.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slide,application\/vnd.ms-powerpoint.slide.macroEnabled.12,application\/onenote,application\/oxps,application\/vnd.ms-xpsdocument,application\/vnd.oasis.opendocument.text,application\/vnd.oasis.opendocument.presentation,application\/vnd.oasis.opendocument.spreadsheet,application\/vnd.oasis.opendocument.graphics,application\/vnd.oasis.opendocument.chart,application\/vnd.oasis.opendocument.database,application\/vnd.oasis.opendocument.formula,application\/wordperfect,application\/vnd.apple.keynote,application\/vnd.apple.numbers,application\/vnd.apple.pages,image\/heif\" tabindex=\"-1\"><button id=\"forminator-field-upload-1_6a9f97f165672_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_6a9f97f165672\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-1993--page-3\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-1993--page-3-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"3\"\n\t\t\t\tdata-label=\"Respuesta Corta\"\n\t\t\t\tdata-actual-label=\"Page 4\"\n\t\t\t\tdata-name=\"page-break-5\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-9\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-9-6a9f97f165672-label\"><span id=\"forminator-radiogroup-radio-9-6a9f97f165672-label\" class=\"forminator-label\">\u00bfCu\u00e1ntos meses est\u00e1 atrasado en su factura de servicios p\u00fablicos? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-9-label-1\" for=\"forminator-field-radio-9-1-6a9f97f165672\" class=\"forminator-radio\" title=\"Ya no atrasado\"><input type=\"radio\" name=\"radio-9\" value=\"one\" id=\"forminator-field-radio-9-1-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-9-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ya no atrasado<\/span><\/label><label id=\"forminator-field-radio-9-label-2\" for=\"forminator-field-radio-9-2-6a9f97f165672\" class=\"forminator-radio\" title=\"1 mes atrasado\"><input type=\"radio\" name=\"radio-9\" value=\"two\" id=\"forminator-field-radio-9-2-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-9-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">1 mes atrasado<\/span><\/label><label id=\"forminator-field-radio-9-label-3\" for=\"forminator-field-radio-9-3-6a9f97f165672\" class=\"forminator-radio\" title=\"2 meses atrasados\"><input type=\"radio\" name=\"radio-9\" value=\"2-months-behind\" id=\"forminator-field-radio-9-3-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-9-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">2 meses atrasados<\/span><\/label><label id=\"forminator-field-radio-9-label-4\" for=\"forminator-field-radio-9-4-6a9f97f165672\" class=\"forminator-radio\" title=\"3 meses o m\u00e1s atrasados\"><input type=\"radio\" name=\"radio-9\" value=\"3-or-more-months-behind\" id=\"forminator-field-radio-9-4-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-9-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">3 meses o m\u00e1s atrasados<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a9f97f165672-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a9f97f165672-label\" class=\"forminator-label\">\u00bfPara cuales meses debe? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-1-6a9f97f165672\" class=\"forminator-checkbox\" title=\"enero\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-1-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">enero<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-2-6a9f97f165672\" class=\"forminator-checkbox\" title=\"febrero\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-2-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">febrero<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-3-6a9f97f165672\" class=\"forminator-checkbox\" title=\"marzo\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"March\" id=\"forminator-field-checkbox-1-3-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-3-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">marzo<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-4-6a9f97f165672\" class=\"forminator-checkbox\" title=\"abril\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"April\" id=\"forminator-field-checkbox-1-4-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-4-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">abril<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-5-6a9f97f165672\" class=\"forminator-checkbox\" title=\"mayo\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"May\" id=\"forminator-field-checkbox-1-5-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-5-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">mayo<\/span><\/label><label id=\"forminator-field-checkbox-1-6-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-6-6a9f97f165672\" class=\"forminator-checkbox\" title=\"junio\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"June\" id=\"forminator-field-checkbox-1-6-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-6-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">junio<\/span><\/label><label id=\"forminator-field-checkbox-1-7-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-7-6a9f97f165672\" class=\"forminator-checkbox\" title=\"julio\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"July\" id=\"forminator-field-checkbox-1-7-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-7-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">julio<\/span><\/label><label id=\"forminator-field-checkbox-1-8-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-8-6a9f97f165672\" class=\"forminator-checkbox\" title=\"agosto\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"August\" id=\"forminator-field-checkbox-1-8-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-8-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">agosto<\/span><\/label><label id=\"forminator-field-checkbox-1-9-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-9-6a9f97f165672\" class=\"forminator-checkbox\" title=\"septiembre\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"September\" id=\"forminator-field-checkbox-1-9-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-9-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">septiembre<\/span><\/label><label id=\"forminator-field-checkbox-1-10-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-10-6a9f97f165672\" class=\"forminator-checkbox\" title=\"octubre\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"October\" id=\"forminator-field-checkbox-1-10-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-10-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">octubre<\/span><\/label><label id=\"forminator-field-checkbox-1-11-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-11-6a9f97f165672\" class=\"forminator-checkbox\" title=\"noviembre\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"November\" id=\"forminator-field-checkbox-1-11-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-11-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">noviembre<\/span><\/label><label id=\"forminator-field-checkbox-1-12-6a9f97f165672-label\" for=\"forminator-field-checkbox-1-12-6a9f97f165672\" class=\"forminator-checkbox\" title=\"diciembre\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"December\" id=\"forminator-field-checkbox-1-12-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-1-12-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">diciembre<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-2\" class=\"forminator-field-currency forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-currency-2_6a9f97f165672\" id=\"forminator-field-currency-2_6a9f97f165672-label\" class=\"forminator-label\">\u00bfCu\u00e1l es el monto total que debe? <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-2\" value=\"\" placeholder=\"Ej. 300\" id=\"forminator-field-currency-2_6a9f97f165672\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-3\" class=\"forminator-field-currency forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-currency-3_6a9f97f165672\" id=\"forminator-field-currency-3_6a9f97f165672-label\" class=\"forminator-label\">\u00bfCu\u00e1l es la cantidad por la que est\u00e1 solicitando asistencia? Este n\u00famero puede ser el mismo que el monto total que debe. <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-3\" value=\"\" placeholder=\"Ej. 250\" id=\"forminator-field-currency-3_6a9f97f165672\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12\"><label for=\"forminator-field-date-1\" id=\"forminator-field-date-1-label\" class=\"forminator-label\">\u00bfCu\u00e1ndo es\/fue la fecha de vencimiento? <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-date-select\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-1-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-1993__field--date-1-month_6a9f97f165672\" id=\"forminator-field-1993__field--date-1-month_6a9f97f165672-label\" class=\"forminator-label\">Mes<\/label><select name=\"date-1-month\" id=\"forminator-field-1993__field--date-1-month_6a9f97f165672\" class=\"forminator-select2\" data-format=\"mm\/dd\/yy\" data-parent=\"date-1\" aria-labelledby=\"forminator-field-1993__field--date-1-month_6a9f97f165672-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Select month<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><\/div><\/div><div id=\"date-1-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-1993__field--date-1-day_6a9f97f165672\" id=\"forminator-field-1993__field--date-1-day_6a9f97f165672-label\" class=\"forminator-label\">D\u00eda<\/label><select name=\"date-1-day\" id=\"forminator-field-1993__field--date-1-day_6a9f97f165672\" class=\"forminator-select2\" data-format=\"mm\/dd\/yy\" data-parent=\"date-1\" aria-labelledby=\"forminator-field-1993__field--date-1-day_6a9f97f165672-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Select day<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><\/div><\/div><div id=\"date-1-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-1993__field--date-1-year_6a9f97f165672\" id=\"forminator-field-1993__field--date-1-year_6a9f97f165672-label\" class=\"forminator-label\">A\u00f1o<\/label><select name=\"date-1-year\" id=\"forminator-field-1993__field--date-1-year_6a9f97f165672\" class=\"forminator-select2\" data-format=\"mm\/dd\/yy\" data-parent=\"date-1\" aria-labelledby=\"forminator-field-1993__field--date-1-year_6a9f97f165672-label\" data-default-value=\"2026\"><option value=\"\" >Select Year<\/option><option value=\"2126\" >2126<\/option><option value=\"2125\" >2125<\/option><option value=\"2124\" >2124<\/option><option value=\"2123\" >2123<\/option><option value=\"2122\" >2122<\/option><option value=\"2121\" >2121<\/option><option value=\"2120\" >2120<\/option><option value=\"2119\" >2119<\/option><option value=\"2118\" >2118<\/option><option value=\"2117\" >2117<\/option><option value=\"2116\" >2116<\/option><option value=\"2115\" >2115<\/option><option value=\"2114\" >2114<\/option><option value=\"2113\" >2113<\/option><option value=\"2112\" >2112<\/option><option value=\"2111\" >2111<\/option><option value=\"2110\" >2110<\/option><option value=\"2109\" >2109<\/option><option value=\"2108\" >2108<\/option><option value=\"2107\" >2107<\/option><option value=\"2106\" >2106<\/option><option value=\"2105\" >2105<\/option><option value=\"2104\" >2104<\/option><option value=\"2103\" >2103<\/option><option value=\"2102\" >2102<\/option><option value=\"2101\" >2101<\/option><option value=\"2100\" >2100<\/option><option value=\"2099\" >2099<\/option><option value=\"2098\" >2098<\/option><option value=\"2097\" >2097<\/option><option value=\"2096\" >2096<\/option><option value=\"2095\" >2095<\/option><option value=\"2094\" >2094<\/option><option value=\"2093\" >2093<\/option><option value=\"2092\" >2092<\/option><option value=\"2091\" >2091<\/option><option value=\"2090\" >2090<\/option><option value=\"2089\" >2089<\/option><option value=\"2088\" >2088<\/option><option value=\"2087\" >2087<\/option><option value=\"2086\" >2086<\/option><option value=\"2085\" >2085<\/option><option value=\"2084\" >2084<\/option><option value=\"2083\" >2083<\/option><option value=\"2082\" >2082<\/option><option value=\"2081\" >2081<\/option><option value=\"2080\" >2080<\/option><option value=\"2079\" >2079<\/option><option value=\"2078\" >2078<\/option><option value=\"2077\" >2077<\/option><option value=\"2076\" >2076<\/option><option value=\"2075\" >2075<\/option><option value=\"2074\" >2074<\/option><option value=\"2073\" >2073<\/option><option value=\"2072\" >2072<\/option><option value=\"2071\" >2071<\/option><option value=\"2070\" >2070<\/option><option value=\"2069\" >2069<\/option><option value=\"2068\" >2068<\/option><option value=\"2067\" >2067<\/option><option value=\"2066\" >2066<\/option><option value=\"2065\" >2065<\/option><option value=\"2064\" >2064<\/option><option value=\"2063\" >2063<\/option><option value=\"2062\" >2062<\/option><option value=\"2061\" >2061<\/option><option value=\"2060\" >2060<\/option><option value=\"2059\" >2059<\/option><option value=\"2058\" >2058<\/option><option value=\"2057\" >2057<\/option><option value=\"2056\" >2056<\/option><option value=\"2055\" >2055<\/option><option value=\"2054\" >2054<\/option><option value=\"2053\" >2053<\/option><option value=\"2052\" >2052<\/option><option value=\"2051\" >2051<\/option><option value=\"2050\" >2050<\/option><option value=\"2049\" >2049<\/option><option value=\"2048\" >2048<\/option><option value=\"2047\" >2047<\/option><option value=\"2046\" >2046<\/option><option value=\"2045\" >2045<\/option><option value=\"2044\" >2044<\/option><option value=\"2043\" >2043<\/option><option value=\"2042\" >2042<\/option><option value=\"2041\" >2041<\/option><option value=\"2040\" >2040<\/option><option value=\"2039\" >2039<\/option><option value=\"2038\" >2038<\/option><option value=\"2037\" >2037<\/option><option value=\"2036\" >2036<\/option><option value=\"2035\" >2035<\/option><option value=\"2034\" >2034<\/option><option value=\"2033\" >2033<\/option><option value=\"2032\" >2032<\/option><option value=\"2031\" >2031<\/option><option value=\"2030\" >2030<\/option><option value=\"2029\" >2029<\/option><option value=\"2028\" >2028<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" selected=\"selected\">2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-1993--page-4\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-1993--page-4-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"4\"\n\t\t\t\tdata-label=\"Page  4\"\n\t\t\t\tdata-actual-label=\"Respuesta Corta\"\n\t\t\t\tdata-name=\"page-break-4\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-6a9f97f165672-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-6a9f97f165672-label\" class=\"forminator-label\">\u00bfEst\u00e1 recibiendo ingresos? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-2-1-6a9f97f165672-label\" for=\"forminator-field-checkbox-2-1-6a9f97f165672\" class=\"forminator-checkbox\" title=\"No tengo ingresos\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-2-1-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No tengo ingresos<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6a9f97f165672-label\" for=\"forminator-field-checkbox-2-2-6a9f97f165672\" class=\"forminator-checkbox\" title=\"Trabajo tiempo completo\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-2-2-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Trabajo tiempo completo<\/span><\/label><label id=\"forminator-field-checkbox-2-3-6a9f97f165672-label\" for=\"forminator-field-checkbox-2-3-6a9f97f165672\" class=\"forminator-checkbox\" title=\"Trabajo parte tiempo\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"I-work-part-time\" id=\"forminator-field-checkbox-2-3-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-2-3-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Trabajo parte tiempo<\/span><\/label><label id=\"forminator-field-checkbox-2-4-6a9f97f165672-label\" for=\"forminator-field-checkbox-2-4-6a9f97f165672\" class=\"forminator-checkbox\" title=\"Recibo otra forma de ingreso como SSI o discapacidad\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"I-receive-another-form-of-income-like-SSI-or-disability\" id=\"forminator-field-checkbox-2-4-6a9f97f165672\" aria-labelledby=\"forminator-field-checkbox-2-4-6a9f97f165672-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Recibo otra forma de ingreso como SSI o discapacidad<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-4\" class=\"forminator-field-currency forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-currency-4_6a9f97f165672\" id=\"forminator-field-currency-4_6a9f97f165672-label\" class=\"forminator-label\">\u00bfCu\u00e1l es el monto de su ingreso mensual actual? <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-4\" value=\"\" placeholder=\"Ej. 1500\" id=\"forminator-field-currency-4_6a9f97f165672\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">USD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-10\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-10-6a9f97f165672-label\"><span id=\"forminator-radiogroup-radio-10-6a9f97f165672-label\" class=\"forminator-label\">\u00bfEst\u00e1 buscando trabajo actualmente? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-10-label-1\" for=\"forminator-field-radio-10-1-6a9f97f165672\" class=\"forminator-radio\" title=\"S\u00ed\"><input type=\"radio\" name=\"radio-10\" value=\"one\" id=\"forminator-field-radio-10-1-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-10-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">S\u00ed<\/span><\/label><label id=\"forminator-field-radio-10-label-2\" for=\"forminator-field-radio-10-2-6a9f97f165672\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-10\" value=\"two\" id=\"forminator-field-radio-10-2-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-10-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><label id=\"forminator-field-radio-10-label-3\" for=\"forminator-field-radio-10-3-6a9f97f165672\" class=\"forminator-radio\" title=\"Ya tengo trabajo o no puedo trabajar\"><input type=\"radio\" name=\"radio-10\" value=\"I-already-have-a-job-or-I-am-unable-to-work\" id=\"forminator-field-radio-10-3-6a9f97f165672\" aria-labelledby=\"forminator-field-radio-10-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ya tengo trabajo o no puedo trabajar<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-1993--page-5\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-1993--page-5-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"5\"\n\t\t\t\tdata-label=\"Respuesta Corta\"\n\t\t\t\tdata-actual-label=\"Respuesta Larga\"\n\t\t\t\tdata-name=\"\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a9f97f165672\" id=\"forminator-field-textarea-2_6a9f97f165672-label\" class=\"forminator-label\">\u00bfPor qu\u00e9 est\u00e1 atrasado en el pago de su factura de servicios p\u00fablicos? Por favor, describa todo lo que desee. <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a9f97f165672\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a9f97f165672\" id=\"forminator-field-textarea-3_6a9f97f165672-label\" class=\"forminator-label\">Si CAIN puede ayudar, \u00bfcu\u00e1l es su plan en el futuro para poder pagar su servicio p\u00fablico? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6a9f97f165672\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a9f97f165672\" id=\"forminator-field-textarea-4_6a9f97f165672-label\" class=\"forminator-label\">\u00bfHay algo m\u00e1s que le gustar\u00eda que CAIN supiera al revisar su solicitud? (Si alguien en el hogar est\u00e1 esperando beneficios, a punto de comenzar un nuevo trabajo, etc\u00e9tera).<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6a9f97f165672\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a9f97f165672\" id=\"forminator-field-text-1_6a9f97f165672-label\" class=\"forminator-label\">Si alguien lo ayud\u00f3 a completar este formulario, escriba su nombre y relaci\u00f3n con usted en el cuadro a continuaci\u00f3n. Si usted mismo llen\u00f3 este formulario, omita esta pregunta.<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a9f97f165672\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Entregar solicitud<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"5f75317af7\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/375\" \/><input type=\"hidden\" name=\"form_id\" value=\"1993\"><input type=\"hidden\" name=\"page_id\" value=\"375\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/caincincy.org\/es\/utility\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/form><\/div>\n<\/details>\n\n\n\n<h2 class=\"wp-block-heading is-style-info\">Recursos adicionales para asistencia con renta y servicios p\u00fablicos:<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>St. Vincent de Paul<\/strong>&nbsp;<br><a href=\"https:\/\/www.svdpcincinnati.org\/get-help\/services-at-the-neyer-outreach-center\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.svdpcincinnati.org\/get-help\/services-at-the-neyer-outreach-center\/<\/a>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">513-421-0602&nbsp;<br>Ofrecen asistencia para renta, servicios p\u00fablicos, hipotecas o dep\u00f3sitos de seguridad cuando tienen fondos disponibles. La asistencia no est\u00e1 garantizada. La forma m\u00e1s f\u00e1cil de solicitar ayuda es en l\u00ednea a trav\u00e9s del enlace anterior. Tambi\u00e9n puedes llamar a su l\u00ednea de ayuda.&nbsp;<br>&nbsp;<br><strong>The Salvation Army<\/strong>&nbsp;<br>513-762-5660&nbsp;<br>Ofrecen asistencia para renta y servicios p\u00fablicos cuando tienen fondos disponibles. La asistencia no est\u00e1 garantizada. Llama para solicitar una cita en persona.&nbsp;<br>&nbsp;<br><strong>Community Action Agency<\/strong>&nbsp;<br><a href=\"https:\/\/www.cincy-caa.org\/what-we-do\/supportive-services\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.cincy-caa.org\/what-we-do\/supportive-services\/<\/a>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">513-685-4478&nbsp;<br>Ofrecen asistencia para renta cuando tienen fondos disponibles. Visita el sitio web para encontrar la solicitud.&nbsp;<br>Tambi\u00e9n ofrecen asistencia para solicitar PIPP (ayuda con el pago de servicios p\u00fablicos para familias de bajos ingresos). Llama al n\u00famero anterior para asistencia con PIPP.&nbsp; &nbsp;<br>&nbsp;<br><strong>Duke Energy y Cincinnati Water Works <\/strong>Permiten establecer planes de pago para saldos vencidos. Llama al n\u00famero en tu factura o visita el portal de tu cuenta para m\u00e1s informaci\u00f3n.&nbsp;<br>&nbsp;<br><strong>United Way &#8211; 211<\/strong>&nbsp;<br><a href=\"https:\/\/www.uwgc.org\/get-help\/united-way-211\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.uwgc.org\/get-help\/united-way-211<\/a>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pueden conectarte con recursos locales que podr\u00edan ayudarte. Llama al 211 o visita el sitio web para obtener m\u00e1s informaci\u00f3n.&nbsp;<\/p>","protected":false},"excerpt":{"rendered":"<p>Please read: Starting in March 2025, CAIN will only offer utility assistance, and not rent assistance. CAIN is able to offer utility assistance to Northside (zipcode 45223) residents when funding is available. Applying for utility assistance does not guarantee that CAIN will be able to assist you. Please fill out the form by following the [&hellip;]<\/p>\n","protected":false},"author":11484899,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_wpcom_ai_launchpad_about_page":false,"_wpcom_ai_launchpad_gallery_page":false,"_wpcom_ai_launchpad_contact_page":false,"_wpcom_ai_launchpad_events_page":false,"_wpcom_ai_launchpad_video_page":false,"_wpcom_ai_launchpad_portfolio_piece":false,"footnotes":""},"class_list":["post-375","page","type-page","status-publish","hentry"],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/PKTDB-63","_links":{"self":[{"href":"https:\/\/caincincy.org\/es\/wp-json\/wp\/v2\/pages\/375","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/caincincy.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/caincincy.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/caincincy.org\/es\/wp-json\/wp\/v2\/users\/11484899"}],"replies":[{"embeddable":true,"href":"https:\/\/caincincy.org\/es\/wp-json\/wp\/v2\/comments?post=375"}],"version-history":[{"count":58,"href":"https:\/\/caincincy.org\/es\/wp-json\/wp\/v2\/pages\/375\/revisions"}],"predecessor-version":[{"id":8781,"href":"https:\/\/caincincy.org\/es\/wp-json\/wp\/v2\/pages\/375\/revisions\/8781"}],"wp:attachment":[{"href":"https:\/\/caincincy.org\/es\/wp-json\/wp\/v2\/media?parent=375"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}