Alimony and/or Child Support Form You will need this form to prove how much alimony or child support you have PAID or RECEIVED. Paid receipts will be deducted from your income, and Received will be added as unearned income.
Correction Request Form This form is used by HEAT workers to correct case files.
Employer Verification Statement You will need this form to be completed by your employer if you have no other record of wages, if you have recently lost you job for one reason or another, or for temporary employment verification.
Forms Order Form 2009-2010 This form is only for HEAT workers to order various forms to use in their jobs.
Instructions to mail in a HEAT application with addresses for office by county This form has instructions and a mailing list of where to mail of every county in the state of Utah. You must mail it to the address that corresponds to the county in which you live.
Instructions in SPANISH for mailing a HEAT application Instrucciones de envió de la solicitud (HEAT)
Landlord Statement You will need this form if you do not pay your utility bills directly, i.e., one or both are included as part of your rent and a portion of your rent goes toward paying that utility. This form will need to be completed and signed by your landlord and returned with your HEAT application.
Lost Check Affidavit Use this form if a client has lost his check and needs to have it replaced. Print 2 copies, one for the client and one for the file.
Medical Release Statement You will need this form completed by a physician to verify that you have a disability or medical condtions which prevents you from working for at least 6 months. Persons with qualifying disabilities receive an additional $50.00 to their HEAT benefit.
MORATORIUM (Utility) Protection Form This form is used by HEAT workers to apply for utility moratorium protection to be used only between November 15 and March 15. Make 2 copies, one for the client and one for the file. Make sure the client reads, initials, and sign the "rights and responsibilities" on the second page.
Required Verification Checklist This form is used by HEAT workers when clients do not have all their needed verification. Print 2 copies, one for file and one for client.
State Energy Assistance and Lifeline Program Brochure Print and distribute SEAL brochures.
Self Employment Form You will need this form to list your net proft income for the month prior to the month you apply for HEAT.
SPANISH Declaration Statement This form is the client's declaration that the information they provide is accurate and where clients give aurthorization to the state and other agencies to assist in processing the application.
Utility Vendors List Energy suppliers who have contracts with the HEAT program.
Weatherization Referral Form Provide to a client who may need this program.
Zero Income Statement You will need this form if you are claiming zero income or insufficient income to meet your needs. You will also need this form if you have other adults in the home who have no income (excluding a spouse).
Zero Income Statement in SPANISH