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Sidewalk Snow & Ice Removal Assistance Application

  1. Seniors and people with mobility challenges may qualify for sidewalk snow and ice removal assistance through the DBQ Shovel Crew Program. To be considered for the program, applicants must reside in Dubuque and meet the eligibility requirements. To qualify, the property must be:

    1. Owner-occupied AND 
    2. The resident must be physically unable to remove snow and ice from the sidewalks AND
    3. Meet the income guidelines.
  2. Applicant Information
  3. Number of People in Household
  4. Required Income Verification
    • If income tax was filed for previous year, attach copy of last year Federal Income Tax return (as submitted to IRS) including copies of W-2’s.
       
    • If no income tax was filed, state source of income and attach verification of income such as Social Security, Pension, Child Support, etc.

     

    I/We authorize the City of Dubuque to contact my source of income, including employer, in order to verify amounts for purpose of qualification for the Financial Assistance Program.  

     

    I /We certify that the information given to the City of Dubuque, Engineering Department is, to the best of my/our knowledge and belief, true, correct, and complete as stated herein. I/We are aware that the information being provided is subject to verification by the local or Federal government. I/We also understand that false statements of information are grounds for denial of assistance.

  5. Physical and/or Mobility Impairment or Disability

    I/We certify that due to a physical and/or mobility impairment or disability, I/we are unable to comply with the provisions of Dubuque Code of Ordinances, Title 10-1-3-C, and State of Iowa Code, Chapter 364.12 responsibility for public places requiring the clearing of snow and ice accumulation from the sidewalks at my/our property. 

  6. Will accept volunteer from Elm Street Correctional Facility?*
  7. The following demographics information is confidential and for reporting purposes only. If you have any questions regarding this form, please contact the Office of City Engineering at (563) 589-4159. 

  8. Ethnicity
  9. Race
  10. Is the person you are applying for from a home where there is a female head of household?
  11. Leave This Blank:

  12. This field is not part of the form submission.