cover image: F S D - Application for Financial Help to Heat or Cool Your Home Low Income Home Energy Assistance Program (LIHEAP)

20.500.12592/47x64x

F S D - Application for Financial Help to Heat or Cool Your Home Low Income Home Energy Assistance Program (LIHEAP)

4 Sep 2018

When to apply for LIHEAP • Send your application to arrive October 1st or after if: Any member of your household is age 60 or over, or if any household member is disabled. [...] • When you pay your heating or cooling bill, send it to the utility company that sent you the bill, not to the LIHEAP agency. [...] • Applicants whose heat has been disconnected or may be disconnected soon: • Send a copy of your disconnection notice along with the fuel statement or utility bill mentioned above, and • If you or someone in your household suffers from a life threatening medical condition, send a medical statement from a qualified doctor or nurse. [...] Did anyone pay court-ordered Child Support last month to someone outside of your household? Yes   No If yes, how much? Name of person who pays the Child Support $ List the 8-digit Child Support Case Number Part 6 – Income That Isn’t Earned If anyone in your household receives income that does not come from a job or self-employment: • Fill in this section, and • Send copies of papers that show all. [...] Part 9 – Your Consent for the LIHEAP Agency to Process (Review) This Application Read the Consent for Processing in the box below and sign in blue or black ink.

Authors

SPC/TAM

Pages
6
Published in
United States of America