Follow the steps to fill out the form online.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by providing your identifying information. Fill in your full name, mailing address, city, state, county, and zip code. If you lack a telephone, include the name of a relative or neighbor to take messages.
3. Indicate whether you are applying for Regular or Emergency LIEAP by checking the appropriate box.
4. Check any benefits you or a household member currently receive, such as SNAP Benefits, WV WORKS, or Medicaid.
5. List the names, birth dates, social security numbers, and relationships of all individuals living in your household. Ensure to mark if they are U.S. Citizens.
6. Provide your total monthly income before deductions, along with the source of employment.
7. Complete the home heating information section by answering whether the name on your heating bill differs from the applicant's name, and specify your current living arrangement.
8. Indicate your primary source of home heating and whether you share this source with another household.
9. Provide details regarding the payment for home heating costs and any relevant monthly averages.
10. In the signatures and statements section, review each statement carefully. Mark the appropriate boxes to confirm your understanding and agreement.
11. Provide your signature and date, as well as the signature of any individual who assisted you in filling out the form.
12. Once all information is completed, save your changes. You can download, print, or share the completed form as needed.

Start filling out your application online today for assistance with your energy costs.