Get Blank Utility Usage Form

Filling out the Blank Utility Usage Form online can streamline your request for assistance with utilities. This guide provides detailed instructions to help you complete each section of the form accurately and efficiently.

Follow the steps to complete your form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by providing household information. List all members, starting with the head of the household. Include names, social security numbers, sex, date of birth, relationships, and ages for each individual.
3. Enter your address details, including street address, city, state, zip code, and county. Also, provide your phone number and email for contact purposes.
4. Indicate the specific type of assistance needed. Attach supporting documentation, such as a utility bill for assistance, a lease for rent, or a mortgage statement.
5. Check the reason for assistance needed from the list provided. This could include insufficient income, high medical bills, loss of income, or other unexpected expenses.
6. Explain your need for assistance in the provided space. Include verification documentation to support your claims, making sure to only attach copies.
7. If applicable, answer the medical exception questions, indicating if any household member has a life-threatening condition and provide details as required.
8. Complete the income information section for each household member. List sources of income and the monthly amounts received.
9. Fill out the budget information section. List all regular monthly expenses, detailing each expense clearly. This includes food, shelter, utilities, transportation, and other expenditures.
10. Review the important information provided. Sign the application where indicated, ensuring that all adults in the household have signed it.
11. Finally, save changes to the form. You may choose to download, print, or share the form as required.

Start completing your Blank Utility Usage Form online now to ensure you receive the assistance you need.