# VOUCHER GUIDELINES Eligible funding amount may include the total purchase and installation costs of the new device.

1. New certied wood or pellet devices must be identied on the list of EPA Certied Wood Heaters to be eligible for Burn Cleaner. 2. To be eligible, the gas replace must be certied as heater-rated, which are tested using the American National Standard ANSI Z21.88/CSA

2.33 (Vented Gas Fireplace Heaters). Gas replaces that are designed exclusively for aesthetic and decorative use are not eligible.

• Do not make any non-refundable payments or install your new device until you receive a District Voucher.

• Gas stoves, gas inserts, gas replaces, or devices with a gas log are not eligible for replacement through this program. • The applicant is limited to one voucher per device address. • The applicant of the real property must not be subject to any related District, state or federal rules or regulations that require a replacement or permanent destruction of the old device, such as District Rule 4901 – Wood Burning Fireplaces and Wood Burning Heaters (i.e., you can not be purchasing the new device in preparation for the sale of a house). • The real property, where the device is to be installed, must be located within the San Joaquin Valley (SJV) air basin, which includes the following counties: San Joaquin, Stanislaus, Merced, Madera, Fresno, Kings, Tulare and the SJV portion of Kern County. • Installation of a new device must be conducted by the contracted Retailer; a third-party contractor under the approval and supervision of the Retailer; or by a certied technician. Self-installation or installation by non-licensed contractor is not eligible under this program. • New device must be purchased from a contracted retailer, for a list of retailers visit www.valleyair.org/burncleaner

.

• Priority will be given to low-income applicants, those purchasing natural-gas devices and those that reside in an area without piped natural-gas service. Low-income Eligibility Form available at www.valleyair.org/burncleaner. • The new device must be installed at the device address for a minimum of three years. 

### REQUIREMENTS & ELIGIBILITY

1. Two pre-installation photos of the old device are required during Phase 1.

• First photo should clearly show device and background, second photo should be a close up with any screen doors open.

• Photos must: a. Show device in its original location and have all original parts intact (i.e. panels, screens, etc.). For freestanding stoves, the Applicant must provide a photo with pipe and ventilation system intact. b. Be taken before any installation of parts for new device (i.e. new electrical outlets, etc). 2. One post-installation photo is required during Phase 3. a. Please provide an explanation if the background is dierent (i.e. major reconstruction)

. • Before and After photos are required , see photo guidelines below: 

### Old Device Type New Freestanding Gas Stove, Gas Insert

or Gas Fireplace 2 New Certied Freestanding Pellet Stove or Certied Pellet Insert 1 New Certied Wood Stove or

Certied Wood Insert 1

P ellet s to v e o r in se r t Non-certied wood insert or stove Certied wood insert or stove Open-hearth replace or wood-burning rebox REPLACEMENT OPTIONS 

### Application Type Eligible Funding Standard for any eligible device below 

### Up to $1,000 Up to $2,500 Up to $500* Low-income for any eligible device below Additional incentive towards gas device (for both Standard and Low-income) *Applies only to eligible installation costs beyond the funding amount.

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# VOUCHER GUIDELINES (Continued)

Homes owned by local Public Housing Authorities and multi-unit residential complexes with more than two units are ineligible. LOW-INCOME APPLICANTS MUST FALL WITHIN ONE OF THE CATEGORIES BELOW: 

### Applicant Status Required Documentation to be submitted with Voucher Application

Low-income Homeowner applying for new device

Reimbursement Available to all qualied applicants. See Burn Cleaner Retailers list for all contracted retailers. Instant Reduction Only available to qualied low-income applicants who purchase from a retailer oering the Instant Reduction option. See Burn Cleaner Retailers List for retailers who provide this payment option. Low-Income Eligibility form and required verication documents.

Low-Income Tenant applying for new device Rental Property Owner/Tenant Approval Form. Low-Income Eligibility form and required verication documents. Current proof of residence at the device address (i.e. most recent utility bill). Copy of the signed lease agreement between the property owner and occupied tenant with a minimum of six (6) months remaining from date of application submittal. If you cannot provide this documentation, please contact Program sta. If the lease agreement is part of the Housing Choice Vouchers Program (formerly Section 8)
, the property owner must provide a copy of the housing assistance payments (HAP) contract or other documents, as approved by the Dist rict. Property Owner with Low-Income Tenant applying for new device on their behalf Rental Property Owner/Tenant Approval Form. Low-Income Eligibility form and required verication documents (to be completed by tenant ). Current proof of residence for tenant at the device address (i.e. most recent utility bill). Copy of the signed lease agreement between the property owner and occupied tenant with a minimum of six (6) months remaining from the date of the application submittal. If you cannot provide this documentation, please contact Program sta. If the lease agreement is part of the Housing Choice Vouchers Program (formerly Section 8)
, provide a copy of the housing assistance payments (HAP) contract or other documents, as approved by the District.



### PAYMENT PROCESS

Payment Options Steps

• After receipt of an approved voucher, applicant purchases an eligible new device from participating program retailer and pays for the entire cost of the new device, including installation.

• After making full payment, applicant submits a completed claim for payment packet to the District for reimbursement to the applicant. • After receipt of an approved voucher, applicant purchases an eligible new device from a retailer participating in the Instant Reduction Option and only pays for the cost of the new device and installation that exceeds the voucher amount. Voucher amount is applied directly at point of purchase through the retailer to reduce the out-of-pocket cost. • Applicant signs the voucher and gives the claim for payment packet to the retailer, who will submit it directly to the District for reimbursement of the reduced amount. For installations completed by a subcontractor (not retailer), applicant will need to submit a separate claim directly to the District for reimbursement of any remaining voucher amount.

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### ADDITIONAL DOCUMENTATION REQUIRED for Tenants and Low-Income Applicants

Rental Property Owner/Tenant Approval Form. Current proof of residence for tenant at the device address (i.e. most recent utility bill). Copy of the signed lease agreement with a minimum of six (6) months remaining from the date of the application submittal. If you cannot provide this documentation, please contact Program sta. Standard Tenants applying for new device