To qualify for equipment, applicants must have a hearing or speech challenge, and receive assistance from a public assistance program administered by a state agency, or an income of 200% or less of the federal poverty guidelines.
Examples of Public Assistance Programs in Utah:
- Children’s Health Insurance Program (CHIP)
- Utah Telephone Assistance Program (UTAP/Lifeline)
- Supplemental Nutrition Assistance Program (SNAP)
- Home Energy Assistance Target Program (HEAT)
RELAY UTAH INCOME GUIDELINES based on 200% of the Federal Poverty Guidelines
|Maximum Household Income Allowed to Qualify|
|Family Size||Gross Monthly Income||Gross Annual Income|
The Application Process
Click the Green “Home Equipment Application” Button to download the PDF Relay Utah Application.
- In order to have your application reviewed by Relay Utah, you will need to download and complete the application (see applications above).
- Include documentation you are receiving assistance from a public assistance program administered by a state agency, or have an income of 200% or less than the federal poverty guidelines.
Income documentation can include:
- Tax returns
- Social Security benefits letter
- Social Security Disability benefits letter (SSDI, SSD)
- Payroll stubs
When submitting documentation, please redact (black out) any sensitive information including account and social security numbers.
- Have one of the following certify the application:
- Licensed Physician
- Licensed Physician Assistant
- Audiologist (AuD)
- Speech-Language Pathologist
- Qualified State Agency Employee
- Mail, fax, or email the application to:
Public Service Commission of Utah
c/o Relay Utah
160 East 300 South, 4th floor
Salt Lake City, UT 84111
The applicant will be notified when the application is approved. The recipient’s legal guardian may sign the application if the recipient is a minor or unable to sign the application.