Keene, TX · Johnson County
Social Security or Disability Payment Schedule Request
Keene utility customers can use this request to ask for a late payment penalty waiver when their Social Security or disability payment arrives after the due date.
What this form is
This request lets Keene utility customers apply to be placed on a list that waives the late payment penalty when Social Security payments arrive after the due date. It asks for customer and utility account details, payment receipt dates, and comments, and requires a copy of an award letter or proof of payments. The signer certifies the information and acknowledges that the waiver applies only to the late penalty.
Who needs it
A Keene utility customer whose Social Security payment arrives after the due date may apply and must provide proof of the payment arrival date.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This request is signed and dated without a notary; attach a copy of the award letter or proof of payments.
How to submit this form
- 1
Download The Form
Download the Social Security or Disability Payment Schedule Request PDF.
- 2
Complete The Request
Enter your contact and utility account details, payment receipt dates, and any comments or concerns.
- 3
Gather Required Proof
Include a copy of your award letter or proof of payments.
- 4
Submit To The City
Submit the completed request to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the Keene Disability Form request?
- It lets utility customers ask to be placed on a list that waives the late payment penalty when Social Security payments arrive after the due date.
- What documents must I include?
- The form requires a copy of an award letter or proof of payments. It also asks for the dates Social Security or disability payments are received.
- Do I need a notary for the Keene Disability Form?
- No. The request is signed and dated without a notary. Include a copy of the award letter or proof of payments.
- How do I submit the Keene Disability Form?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Social Security or Disability Payment Schedule Request doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.