You must have JavaScript enabled to use this form. LADWP offers a number of discount and special rate programs designed to provide assistance to low income families, senior citizens, and the disabled. If you meet certain criteria, you may quality for one of these programs. Please fill out the simple form below and we'll tell you what programs you qualify for. Note: If you qualify for multiple programs, you may only participate in one. Age Members in Household --Select One--12345678910 Gross Annual Income Enter gross income in the same format as this example: 1000 Are you permanently disabled? Yes No Do you or any members of your household have any life support devices in your home? Yes No Select support devices aerosol tents pressure_pads pressure pumps respirators ultrasonic nebulizers breather machines (IPPB) iron lungs hemodialysis machines motorized wheelchairs apnea monitors compressor/concentrators electronic nerve stimulators suction machines electrostatic nebulizers inhalation pulmonary pressure devices dialysis machines oxygen generators Is a full time member of the household being treated for a life threatening illness? Yes No Leave this field blank
