Follow the steps to complete your application online

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Fill in your personal details in the designated fields, including your Social Security Number, home phone number, name, and mailing address. Ensure that all information is accurate and legible.
3. Indicate your household type by checking the appropriate box, whether it be apartment, townhouse, or single-family home. Specify your living situation by selecting homeowner, renter, or roomer/boarder.
4. If you are a renter, answer whether heat is included in your rent. Provide details about your landlord and the property if applicable.
5. List all household members, starting with yourself, including their names, Social Security numbers, birthdates, relationship to the applicant, gender, race, citizenship, and disability status.
6. Provide your electric company information, including your account number and whether you have received a shut-off notice. Also, indicate if you wish to participate in the Utility Service Protection Plan (USPP).
7. Select your primary heating source by checking the corresponding box. Fill in details about your heating supplier, account number, and whether you have received a shut-off notice.
8. Indicate if you wish to be referred to the Weatherization Assistance Program and provide any other relevant information or comments.
9. Sign and date the application, confirming that the information provided is accurate and complete. Be aware of consent regarding income verification.
10. After completing the form, save your changes. You can then download, print, or share the completed application as required before submitting it to the local Office of Home Energy Programs.

Complete your Energy Assistance Application online today to ensure timely support.