Funding is designed to be a one-time opportunity, with only one payment per household (for residential) or account holder and their successors (for non-residential).
Download the form (PDF) using the button below.
If you have questions about eligibility and/or to obtain the amount and statement required for completing the form please call Bernie Camper, Billing Clerk at Sussex Service Authority at 804-834-8930 ext 104, email firstname.lastname@example.org, or visit their website at www.ssa-va.org.
Forms must be completed and submitted along with the statement demonstrating total arrearage from March 1, 2020 - December 30, 2020 from Sussex Service Authority by January 29, 2021.
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