State Energy Assistance & Lifeline

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Instructions for Mailing in HEAT Application Must Use Appropriate Postage! Mailing Instructions

Thank you for your interest in applying for the HEAT Program.  In order to have your application processed in a timely manner, it must be completely filled out and signed. 

YOUR APPLICATION CANNOT BE PROCESSED IF IT IS NOT FILLED OUT COMPLETELY AND/OR

IS LACKING THE REQUIRED D0CUMENTATION

You must enclose all appropriate verifications, and mail to: Where to mail your HEAT application  

Information That Will Need To Be Verified

1. Household Verifications:

  • Copy of your picture identification.
  • Copies of all Social Security cards for everyone in your home who is 18 years and older.
  • Copies of INS documents.

2. Income and Income Deductions Verifications:

  • Copies of the proof(s) of income received in the month prior to the month of your application date by all household members. (Check stubs, Social Security, Retirement, Child Support, Alimony, etc.) Alimony Child Support Form
  • Proof of self employment earnings. Self Employment Worksheet
  • If anyone in your household is a college student receiving financial aid, include a copy of each one you're receiving.  Some examples of financial aid are: loans, grants, scholarships, stipends, assistantships, fellowships, veterans benefits for schooling, workstudy any other types of school financial aid.
  • Copies of proofs of any medical expenses that were paid in the previous month; including health insurance premiums, co-pays, receipts for paid medicine, eyeglasses, dental, and over-the-counter medications.
  • Proof of any child support or alimony paid the previous month, if applicable.
  • If you are claiming zero income, you must complete this form: Zero Income Form

3. Energy Burden Verifications:

  • Copies of your most recent Gas and Electric utility bills. (If for some reason these bills are not in your name, tell us who the person on the bill is and why it is in their name.)
  • If you do not pay for energy costs directly, please provide a landlord’s statement or other verification saying that part of your rent goes toward paying utilities. Landlord Statement Form

4. Target Groups Verifications:

  • Copy of the birth certificate for a child five years old or younger, if in the home.
  • Proof of a disability, if applicable. Medical Disability Form

Remember To Leave a Phone Number Where You Can Be Reached So We Can Call If We Have Question Or You Need Other Documents.

I Have Read And Understand These Instructions: Y N

Download HEAT Application Now:

Interactive HEAT Application You can type directly on this application, and it calculates income and deductions. After completing the application, make sure you sign and date it and KEEP A COPY for your records.

2008-09 HEAT Application (Printable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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