IHSS Portal > Senior Restaurant Eligibility Form ( * Indicates Required Fields )

Senior Restaurant Eligibility Form

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Please contact the Office of Aging by email at: rcAging@rivco.org or by phone 800-510-2020

Applicant Information


I hereby affirm that I am 65 years of age or older or otherwise high risk as indicated by my stated medical condition; I Live alone or with another program eligible adult; I am unable to prepare meals or access additional food resources as a result of the self-isolation period and in abidance of EO N-33-20; I do not currently receive any assistance from a federal nutrition program and do not exceed stated annual income of $74,940 as a single individual or $101,460 in a household of 2 under penalty of perjury.

**Please note that this program is subject to a limited time period and available funding. You will be contacted by the restaurant that is participating in your local area. They will discuss with you the meals available and anticipated time frame to be able to deliver to your home.**

Please complete required fileds (*)

IHSS Portal > Senior Restaurant Eligibility Form

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