Get Ldss 4992 Rev 6 15

Filling out the Ldss 4992 Rev 6 15 form is an essential step for individuals seeking home energy assistance. This guide provides clear instructions to help users easily navigate the form and complete it successfully.

Follow the steps to fill out the Ldss 4992 Rev 6 15 form online.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by providing applicant information in the designated fields, including first name, middle initial, last name, Social Security Number (last four digits), street address, apartment number (if applicable), city, state, county, zip code, and daytime phone number.
3. Next, fill out the household information section. List each person living in your household, including their names, Social Security Numbers, dates of birth, and indicate if they are blind or disabled.
4. If there are more than three individuals in your household, continue listing their information on the reverse side of the form.
5. Indicate whether any member of the household has a medical condition worsened by extreme heat. If so, prepare to provide a note from a qualified medical professional dated within the previous twelve months.
6. Carefully read the certification section. By signing, you affirm that all provided information is accurate and consent to investigations related to your application.
7. Complete the signature and date fields to finalize your application.
8. Once all sections are completed, save your changes, and choose to download, print, or share the form as needed.

Start filling out your Ldss 4992 Rev 6 15 form online today!