General Welfare Consolidated Benefit Amount Adjustment

This form is to be used to make an adjustment to a Tribal Member’s monthly GW Consolidated distribution, this form cannot be used to apply or recertify for the benefit.

As of October 1, 2024 the current benefit allowances are as follows:

Adults are eligible for up to $3350 in funds per month towards eligible expenses
Elders are eligible for up to $3950 in funds per month towards eligible expenses. (Elders must mark Elders Assistance)

Please complete the form below to request an adjustment to your current funding amount, no supporting documents are required for the adjustment. You will still be required to recertify on your annual date.

Name(Required)

First Last

Enrollment Number(Required)

Phone(Required)

Benefit Amount Being Requested Per Month(Required)

Please select the categories in which you intend to utilize the requested funding(Required)

Housing Assistance

Health Care Assistance

Food and Clothing Assistance

Elders Assistance

Definitions

Housing Assistance. Funds shall only be used to pay for Eligible Expenses at the Tribal Member’s primary residence only.

Basic utility services, specifically water, sewer, trash, electricity, gas, and heat source (natural gas/propane/firewood/pellets).
Basic communication services, specifically landline and/or cellular telephone, internet, and basic cable services.
Rent/ Mortgage/ Property Taxes/Assisted Living Facility Room Rent.

Health Care Assistance. Funds shall only be used to pay for eligible medical expenses listed below.

Payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices intended for these purposes.
Premiums one pays for health insurance that covers expenses of medical care; must provide healthcare insurance card
Transportation to receive medical care.
Payments for qualified long-term care services and limited amounts paid for any qualified long-term care insurance contract. Traditional medicine and healers, including homeopathic healers, medicine and practices. Wellness Programs, such as gym memberships, purchase of gym/ wellness equipment, and any items that contribute to overall health and wellness not covered by another program.

Food and Clothing Assistance. Funds shall only be used to pay for Eligible Expenses per household.

Food and personal hygiene expenses. (Ineligible: pet supplies, beer/wine/liquor, energy drinks, cigarettes)
Clothing expenses.

Elders Assistance. Funds available only to Elders 55+

I am 55+ and requesting Elders Assistance.

View the General Welfare Benefit Misuse Policy