LIHEAP Required Documents

Documents Below are required with submission of application.

• Employee Relations Form
• Notice Regarding collection of Social Security numbers Form
• DEO Authorization for Release Form
• Appeal Process
• Duke Energy Release and Authorization Form
• SECO Energy Release and Authorization Form

Additional LIHEAP Documents

Self Declaration Form - No income in past 30 days of occupants over the age of 18
Financial Assistance Form - Assistance provided by any source on a consistent basis
Utility Bill Agreement Form - Accounts not listed in
applicant name or any adult member inside the home

EnergyServices1217@gmail.com

 

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