N.Y. Comp. Codes R. & Regs. tit. 16, Appendices, app A-3
(cf. § 11.5[a])
A Model Letter and Form for Documentation of Inability to Pay Utility Bills
We have received an initial certificate of medical emergency, under which we must continue to provide you with utility service for 30 days, starting ________ and continuing until the beginning of business on ________.
At the expiration of that period, we can, under the provisions of law (sec. 32[3][a], Public Service Law) and Public Service Commission's regulations (16 NYCRR 11.5[a]), terminate your utility service UNLESS the medical condition persists AND you do not have enough ready cash or income to meet your past due and current utility bills and still meet your other necessary expenses such as food, housing and medical treatment.
We enclose a form that you can use to provide the information we need to make a determination, as required by law, whether you are unable to pay past due and current bills. We will continue to provide you with utility service while we consider the information you provide.
If we determine that you have NOT demonstrated that you are unable to pay past due and current bills, we will notify you in writing and inform you how you can seek review of our determination by the Public Service Commission.
If we determine that you have NOT shown that you have a financial hardship, we will offer you a deferred payment agreement, so that you can pay past due bills and installments while you meet all current bills. And if you DO show a financial hardship, we will try to work out an arrangement so that you will not accumulate substantial past due bills.
If you have any questions, you can call (local utility office/customer representative) at xxx-xxxx. If you are not satisfied with our response, you also can call the Public Service Commission during regular business hours at xxx-xxxx, or, in an emergency, you can call the Public Service Commission until 7:30 p.m., Monday through Friday at 1-800-342-3355.
N.Y. Comp. Codes R. & Regs. tit. 16, Appendices, app A-3