Apply for the Bill Discount Program & Winter Shut Off Moratorium

Please complete the following form to begin the registration process. Once your application has been submitted, a PGH2O Cares Representative will contact you within 2 business days.

You can also submit the completed Bill Discount Program and Winter Shut Off Moratorium Application form via mail or email to:

Pittsburgh Water
ATTN: Department of Customer Service, PGH2O Cares
1200 Penn Avenue
Pittsburgh, PA 15222

cares@pgh2o.com

 

Utility Information
If one or more of your utility services are currently off, please identify which ones:
If you have a shut off notice from one or more utilities, please identify which ones:
Please contact your utility immediately if your service is off or in threat of termination - additional assistance may be available.
Customer Information
Service Address
Mailing Address - if different from Service Address
(Optional) Do you rent your home?
Household Information
Total number of household occupants, including you:
Number of Adults (age 18 and over)
Number of Children
Occupant Information
Please provide the following information for all members of the household (adults and children), including you:
First Name, Middle Initial, Last Name Birth Date Before-Tax Income Income Source(s) Operations
Zero-Income Form
Household Zero Income Claim:

Household Expenses:

Identify how you and your household meet monthly living expenses, such as those expenses or housing (mortgage or rent), food, and utilities (electric, gas, water, and/or phone bill). Check all that apply:

Affidavit: 

I certify that the information presented in this application is true and accurate to the best of my knowledge. I understand that providing false information in this application is grounds for denial and dismissal of my application. I acknowledge that I am responsible for notifying Pittsburgh Water if my household or income information changes.

Utility Provider
By selecting my utilities below, I understand that I am consenting to share my information with them for the limited purpose of helping me enroll and/or recertify in utility assistance programs that I qualify for. I understand these utilities may need to contact me for additional information before determining my eligibility for their assistance programs. 
Please select the utilities that provide your electric:

Please select the utilities that provide your electric:

Please select the utilities that provide your water:

Please select the utilities that provide your water:

Please select the utilities that provide your natural gas:

Please select the utilities that provide your natural gas:

Information message

Note: If you do not see your utilities listed above, please contact them directly to find out if they offer any assistance programs.
Information Sharing
Is it okay for Pittsburgh Water to share your contact and/or income information with other utilities in an effort to cross enroll customers in all available assistance programs?
Is it okay for Pittsburgh Water to send you text messages and/or emails regarding updates to our Customer Assistance Programs and when it is time for you to recertify?
Outreach Feedback
How did you hear about Pittsburgh Water’s Customer Assistance Programs?
Lead Question
Are you interested in applying or receiving more information about Pittsburgh Water’s Lead Service Line Replacement Reimbursement Program?

More information about the program is available at https://lead.pgh2o.com/leadreimbursement/. This program is free for income eligible customers.

Please note: This program is only available to customers who receive water services from Pittsburgh Water. A map of our water service area is available at https://www.pgh2o.com/your-water/learn-where-we-provide-our-services.

I affirm that all information on this application is true and complete to the best of my knowledge. I am aware that I can be penalized for making false statements.
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