On Date Application Time a.m. Regular Assistance # Disposition Time Limit 18 hrs. 48 hours p.m. Crisis Intervention # Interviewed By Date APPLICANT: All Sections of this form must be completed in order to determine your eligibility. Failure to complete this application and attach required documentation WILL delay the processing of your application. YOU MUST APPLY AT THE LOCAL COMMUNITY ACTION AGENCY OFFICE WHICH SERVES THE COUNTY IN WHICH YOU LIVE. Affordable Care Act (ACA) – The compre.
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How to fill out the AR DCO 9495 online
Filling out the AR DCO 9495 application is an essential step in applying for assistance under the Arkansas Home Energy Assistance Program. This guide provides clear instructions to help you complete the form accurately and efficiently, ensuring you have all necessary information at hand.
Follow the steps to fill out the application correctly
- Click the ‘Get Form’ button to access the AR DCO 9495 online and open it in your browser.
- Start with the 'Applicant' section, where you will enter your personal details such as your name, mailing address, and contact information. Ensure that you include your Social Security number, age, and whether you have a disability.
- Proceed to the 'Other Household Members' section. List the names and relevant details of all other residents in your household, excluding yourself. Remember to provide their relationship to you and their birth dates.
- In the 'Household Income' section, fill out information about both work and non-work income. Attach the required documentation for your last month's pay stubs and any non-work income received.
- Complete the 'Crisis Applicants' section if applicable. Here, indicate any crisis situations your household faces, such as a utility disconnection notice.
- In the 'Utility/Rent Information' section, specify whether you rent or own your home. If you rent, clarify if energy costs are included in your rent and provide your landlord's contact information if required.
- Fill out the 'Home Energy Supplier Information' section with details of your energy suppliers. Ensure to include each bill and whether the account is active.
- Verify your identity by providing copies of valid identification as required by the LIHEAP policy. This could include a driver's license or other official documents.
- Indicate if you wish to be referred for home weatherization services, but note that this application does not guarantee eligibility for such services.
- Review and sign your application. Make sure to include your name in the signature field and date it. If someone else assisted you, they should also sign in the designated area.
- Once all sections are filled out correctly, save your changes, download a copy for your records, and submit the application as per the instructions provided on the document.
Start filling out the AR DCO 9495 application online today to ensure you receive the assistance you may qualify for.
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