The LIHEAP Program is designed to assist eligible households with very low income, who pay a high portion of household income for home energy to meet their immediate home energy need. Assistance is provided beginning October 1st through September 30th year round or until funds are exhausted.  This applies to Regular Energy Assistance as well as Emergency Crisis Assistance.

LIHEAP Application Guide

Dear Applicant,

Please read your application carefully and make sure it is filled out completely. You must include the following attachments with your mail-in application:

• Valid Government ID
• A copy of the Social Security card for every household member
• Most recent bill along with your current utility company print-out showing last 12 months of usage
• Proof of gross income for anyone in the household age 18+ as well as any minors receiving SSA or SSI
  • If no income, please fill out the LI-03 form, Self-Declaration of Zero Income, following all instructions on the form thoroughly including any additional attachments
  • Requirements based on your frequency of pay:
    • Weekly: You will need 4 consecutive paychecks showing gross income from the time of application back.
    • Bi-weekly: You will need 2 consecutive paychecks showing gross income from the time of application back
    • Monthly: You will need 1 consecutive paycheck showing gross income from the time of application back.

Steps for Filling Out LIHEAP Application

1. Check type of assistance - Regular or Crisis.
   1. Unlike regular applications, Crisis Assistance applications will need to meet crisis guidelines, including that your home utility should be pending disconnection.
   2. Please meet with your local County Service Manager to complete an emergency application due to strict timelines for processing.
2. Circle Yes or No regarding whether you have applied for assistance within the current fiscal year and with which agency.
3. Fill in applicant’s name, telephone number, current address, and mailing address if different from utility service address.
4. List all household members including applicant and requested information concerning each one.
5. Check one box best describing your family type.
6. Fill in Declaration of Disability for any household members with a permanent disability.
   1. Circle Yes or No if life support equipment is required.
   2. If a permanent disability is declared for a household member that does not receive a SSDA or SSI check, you must provide a doctor’s statement stating the disability.
7. List income and employer details for all household members age 18 and up.
8. Check applicant housing type.
9. Circle the source(s) of energy for which you are requesting assistance.
10. LEAVE "HOME ENERGY COSTS" AND "PUBLIC HOUSING/SECTION 8 TENANTS ONLY" BLANK - THIS WILL BE FILLED IN BY OUR AGENCY STAFF
11. If you have more than one utility or energy company, please list the one with which you need assistance first!
12. If the utility or energy account name is different than applicant name, please note this on your application and highlight or circle it.
13. Please read applicant certification section and Check whether you Do or Do Not agree to allow the information in your application to be shared with other agencies.
14. Sign and date the application.
    1. The application should not be dated until the application is fully completed and all required documentation has been gathered.

Crisis Assistance Guidelines

Bill must be either a shut off notice, disconnected utilities, or a lack of home delivered fuel notice that is less than 10%.

Uncontrollable Guidelines:

• Household has an unanticipated medical or major household expense. Out of pocket expense should exceed 100% of current utility bill.
  • Documentation could include: receipts of payments made to meet this unanticipated medical or major household expense.
• Household wage earner with at least a year of stable work history has lost their job within the last 12 months.
  • Documentation could include: letter from employer, termination or lay-off notice, UI claims, UI notification of eligibility.
• Household wage earner has left the home within the past 45 days.
• Documentation could include: recent application for family assistance (Families First, Food Stamps), order of protection, police report, revised lease, or other legal documentation.
• Death of wage earner within the last 12 months. 
• Documentation could include: obituary, death certificate, funeral program.
• Significant loss of work hours. 
  • Documentation could include: letter from employer detailing loss of work hours, pay stubs.
• Household wage earner is unable to work due to illness and does not receive sick leave or time away from work.
• Documentation could include: statement from employer.
• Household has a non-functioning or malfunctioning heating system.
• At least one child age 5 and under in the home.
• At least one elderly (age 60 and up) member of household.
• At least one disabled member of household.

If you have any questions or need more information, please contact the NWTEDC Central Office or your local County Service Manager:

Helpful Resources