Get Ldss 4992

The Ldss 4992 is an essential form for applying for cooling assistance through the Home Energy Assistance Program (HEAP). This guide provides a comprehensive overview and step-by-step instructions to help you complete the form online confidently.

Follow the steps to fill out the Ldss 4992 online effectively.

1. Click the ‘Get Form’ button to access the Ldss 4992 and open it for editing.
2. Begin by entering your applicant information. Input your first name, middle initial, last name, and the last four digits of your Social Security Number (SSN). Continue with your street address, apartment number (if applicable), city, state, county, and zip code. Finally, provide a daytime phone number where you can be reached.
3. Proceed to the household information section. List each individual residing in the same household, including yourself. For each person, enter their name, SSN, date of birth, and indicate whether they are blind or disabled by selecting 'YES' or 'NO.'
4. Answer the question about whether anyone in your household has a medical condition worsened by extreme heat. If 'YES', ensure that you have a physician's note dated within the last twelve months to confirm this condition.
5. Carefully read the certification statement. You must affirm that the information provided is accurate and truthful. This statement highlights the consequences of false information. After reading, sign and date the document to complete your application.
6. Once you have filled out all the required fields and sections, review your entries for accuracy. Save your changes, and you may choose to download, print, or share the form as necessary.

Start filling out your Ldss 4992 online today for cooling assistance!