Get Dhs-355

This guide provides clear instructions for filling out the DHS-355 form online, specifically for energy suppliers participating in Michigan's Low Income Home Energy Assistance Program. Follow these steps to ensure you complete the form accurately and efficiently.

Follow the steps to complete the DHS-355 form.

1. Press the ‘Get Form’ button to obtain the DHS-355 form and open it in your chosen editor.
2. Begin filling out the form with the name of your company in the designated field. Ensure the name is spelled correctly and matches your legal business registration.
3. Enter your business telephone number, including the area code, in the appropriate section of the form.
4. Provide your complete address, including street number and name, city, state, and zip code.
5. Input your Federal Employer ID Number (FEIN). If you do not have an FEIN, use your Social Security Number instead.
6. Indicate the type of fuel supplies provided by your business by checking the relevant boxes. Options include fuel oil, wood, LP gas, coal, kerosene, electricity, natural gas, or other (please specify).
7. Fill out the name and title of the designated contact person for your business, ensuring accuracy for communication purposes.
8. Review all entries for accuracy and completeness before proceeding. It is important that all information provided is true, correct, and complete.
9. Provide the signature of an authorized representative of your energy supply business, along with their title and the date of signing, confirming your adherence to the conditions outlined in the agreement.
10. Once completed, you can save your changes, download, print, or share the DHS-355 form as needed for submission.

Complete your DHS-355 form online today to participate in Michigan's LIHEAP program.