Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Select the type of assistance you are applying for. Indicate if you need regular energy assistance, water assistance, or both by checking the corresponding boxes.
3. If facing disconnection of utilities or if your heating fuel is low, check the crisis box to inform the agency of your current situation.
4. Complete Part I with your contact information. Fill in your full name and the last four digits of your Social Security Number (SSN). Ensure all contact methods are accurate to avoid processing delays.
5. Move on to Part II. Provide details about your home and utility services. It is essential to submit current bills for electricity, heating, and water/wastewater along with this section.
6. In Part III, report all sources of income and any received benefits over the past three months for every household member. Submit current documentation verifying income with your application, especially for members aged 18 or over.
7. Part IV requires you to list all household members, including yourself. Ensure all fields are completed, including demographic information. Use the provided codes to represent race, ethnicity, and employment status for each member.
8. In the final Part V, review the certification statement. Ensure to sign and date the form, as omitting this will invalidate your application.
9. Lastly, prepare your application for submission. Include all required documents such as identification, proof of SSN for each household member, and current utility bills. Submit your completed application to your local service provider, not to IHCDA.

Complete your application online today to access the energy and water assistance you need.