LIHEAP Forms and Publications

HSEA 1

LIHEAP Application Form

HSEA 1-S

LIHEAP Application Form (Spanish)

PWEA 4

Energy Assistance Affidavit

PWEA 4-S

Energy Assistance Affidavit (Spanish)

HSEA 6

Zero Income Statement

HSEA 6-S

Zero Income Statement (Spanish)

PWEA 18

How It Works and Who Can Apply

PWEA 18S

How It Works and Who Can Apply (Spanish)

PWEA34

Vendor Agreement

HSEA 36

Landlord Statement

HSEA 36-S

Landlord Statement (Spanish)

PWEA 37

LIHEAP Program Refund

HSEA 40

DCED/DHS Crisis Interface Referral Form

PWEA 41

Low-Income Home Energy Assistance Program (LIHEAP) Electronic Funds Transfer Application Form

PWEA 51

Conservation Tips to Reduce Energy Usage

PWEA 51-S

Conservation Tips to Reduce Energy Usage (Spanish)

PWEA 99

LIHEAP Information Needed for Supplies

OIG 189

Overpayment Referral